ERING PLEA FOR MEDICAL MISSIONS 3thaca, Sfttn Mark CHARLES WILLIAM WASON COLLECTION CHINA AND THE CHINESE THE GIFT OF CHARLES WILLIAM WASON CLASS OF 1876 1918 Cornell University Library R 722.P13 The claim of suffering a plea for medic 3 1924 024 018 628 Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924024018628 THE CLAI1VJ OF SUFFERING • * >«* -,*•.. MOHAMMEDAN PATIENT WITH HER MOTHER AND BABY, RAMNAD THE CLAIM OF SUFFERING A PLEA FOR MEDICAL MISSIONS BY ELMA K. PAGET ILLUSTRATED SECOND EDITION (Sffoeig for the $rxrpagaiicm at ih* <&oavd in Jforrign fJari* 15 TUFTON STREET, WESTMINSTER, S.W. 1913 NOTE The present volume, although issued by a missionary society, does not deal merely with the work of one particular society, but with the whole subject of the Christian Missions which are being carried on through- out the world. We believe that its perusal will accen- tuate the interest of those who are already familiar with the noble work which is being done by medical missionaries in response to the " claim of suffering " in non-Christian lands, and in the case of others will create a desire to help forward this work by every means within their power. There is no other branch of Christian work of which it can more confidently be affirmed that it only needs to be known to be sup- ported with enthusiasm. We are exceedingly grateful, and the readers of this volume will share our gratitude, to its author who, amidst the distractions of a particu- larly busy life, has made time to write. The gratitude of our readers is also due to the Rev. E. H. Mosse, the Chairman of the S.P.G. Medical Missions Com- mittee, and to Miss Mosse for help in collecting materials and in correcting the proofs of the book. EDITORIAL SECRETARY. S.P.G. House, November, 1912. CONTENTS CHAP. PAGE I. Evil spirits and medicine men i II. Quacks and cures 17 III. The weak and helpless 32 IV. Surmounting difficulties 44 V. The dawn of hope 59 VI. The care of public health 72 VII. Teaching and training 87 VIII. Some s.p.g. hospitals 96 IX. An appeal iog Appendix 117 Index 123 LIST OF ILLUSTRATIONS Mohammedan patient with her mother and baby, Ramnad Frontispiece to face page St. Martin's Hospital, Ramnad i Hospital and school at Banting 8 Out-patients, St. Luke's Hospital, Nazareth ... 24 Doctor, nurse and patient in operating room, St. Catherine's Hospital, Cawnpore 24 In-patients and staff, Ranchi Hospital .... 30 St. Stephen's Hospital, Delhi 38 Evangelist preaching to out-patients, Ranchi Dispensary 48 Patients awaiting treatment, Ranchi Dispensary . . 48 The main entrance, St. Agatha's Hospital, Ping Yin . 52 Village group of patients waiting to be seen, Ping Yin 52 Little girl patients leaving hospital, their grandfather standing on left, St. Catherine's, Cawnpore . . 56 Group at front door, Malacca Medical Mission. Dr. Staley and three assistants behind, four patients IN FRONT 56 Lepers having feet dressed at Jercherla. Dispensary hut in background 60 Dispensary tent, Karnal District 60 Mission Hospital, Rawal Pindi. Contractor and head workman of church standing in front ... 64 Mohammedan convert and her little son, St. Catherine's, Cawnpore 64 vii 68 7° 7 o 74 viii LIST OF ILLUSTRATIONS to face page St. Luke's Hospital, Chemulpo (with Corean houses in the foreground). main hospital building on the left, women's ward on the right . . . . 68 Corfe Ward, St. Luke's Hospital, Chemulpo Village women waiting for medicine . In the consulting room, Rewari Hospital St. Catherine's Hospital, Cawnpore . Taking a patient to the plague hospital, Harbin, N. China 80 A corner in the plague hospital, Harbin, N. China . 80 Dispensary at St. Aidan's Mission House, Durban, S. Africa 84 Consulting room, Karnal. Dr. Scott, out-patients and nurses 92 Biblewoman teaching patients waiting to see the doctor, Karnal 92 St. Lucy's Hospital, St. Cuthbert's, Tsolo ... 98 Bullock cart with patients leaving hospital compound, Karnal 102 Dispensary and compounder, Karnal 102 Dr. Laws and in-patients, Chin-Chun Hospital . . 106 In the Anne Vaudrey Ward, St. Agatha's Hospital, Ping Yin, N. China 110 St. Agatha's Hospital, Ping Yin. Three nurse proba- tioners no Nurses and patients on the site of the new Nurses' Home, St. Stephen's, Delhi, ign 114 Interior of ward, St. Luke's Hospital, Nazareth, S. India n8 St. Luke's Hospital, Nazareth 118 The first hospital at St. Barnabas Mission, Mlengana, Pondoland West I22 The back of Etalaneni Hospital, Zululand. Group of house girls and convalescent children . . . 122 EVIL SPIRITS AND MEDICINE MEN. MISSIONS ! Here indeed is a wide term, though it often receives but a narrow interpretation. What do we really mean by "Missions"? To some it is almost the first clause in a creed, if we may use the word, which begins with " I don't believe ". " I don't believe in missions " people say with a fine sweeping general- ization, and they are eager to back this assertion by an appeal to those who have been abroad whether as travellers or residents. It is clear to such people that missions do a great deal of harm, that they involve our representatives abroad and our ministers at home in international difficulties of no mean importance, besides spoiling the natives and unfitting them for work. But here, as a rule, the critics part company, for while some declare that missions render the native insubordinate and independent, others urge that they keep him in dependence for the capitalist to exploit. If we really wish to understand what effect mission- ary work has upon the natives we must study the various methods of work, the conditions of the country and people before the missionary came, what he claims to have brought them and what the after-effect has been. For when we talk of " Missions " we infer (2M(2)0.I932I) I 2 THE CLAIM OF SUFFERING a great variety of methods ; many means, in fact, to attain the same end, a diversity of operations but the same spirit. There is the evangelistic and pastoral work of preaching and shepherding, including all that we mean when we speak of direct conversion. This must be judged by its fruits, which should be visible in the diminution of slavery and cruelty and in the higher ideals of womanhood and marriage wherever the Faith of Christ is established. There should be a turning from the rough principles of force to the principles of justice and of love, and this should include the care of the weak, of slaves, of widows and children. The study of missions goes far to prove that this change has in fact been made, that new and spiritual ideas have been implanted ; we have seen a cathedral raised on the site of a slave market, and have heard God's praises sung where once murder and tyranny reigned supreme. This is openly acknowledged in the Report of a Royal Commission where it is stated that the hope for the elevation of the African native races must depend mainly on their acceptance of Christian faith and morals. But the word "Missions" includes educational as well as pastoral work, the missionary who is pledged to liberate the soul is also pledged to set free the mind and to take pains that it be formed, trained, de- veloped and controlled. Boys' schools, girls' schools, industrial schools, training and special schools, univer- sity work and university hostels are thus called into existence by these true descendants of the holy men and women of old who gave to us in England and to the EVIL SPIRITS AND MEDICINE MEN 3 glory of God our universities and the foundations of our primary and secondary education. In many cases it is the missionary who has first given to the people a written language and who has brought to them the delight and companionship of books. Again, this comprehensive word " Missions " carries us to a further method, that of medical work. We know well enough that there is laid upon us the care of soul, of mind, and of body — Brother Body as St. Francis called it, and the care of the body is an in- dispensable part of missionary enterprise. And when the missionaries claim that they have been able to re- lieve the suffering, to heal the sick, and to reduce the extent and the terror of sickness, so far as their narrow means in men and money have allowed, it is com- paratively easy to gather evidence and to judge if, after all, their claim be a just one. They have inter- posed — the critics of missions speak of " unwarrantable interference " — and we have to inquire whether there is any justification for such an interference ; whether in this special work of healing the sick in obedience to their Lord's command there has been any improve- ment in the conditions of those to whom they minister, or whether the natives were really happier when " left to themselves " before the missionary came. So we turn, for a moment, from the thought of our God who is love and who is supreme over all His works, to the " gods many and lords many " who are acknow- ledged by the non-Christian people, and we ask what answer has been made by those who believe in them to the bitter cry of pain and suffering and disease. 4 THE CLAIM OF SUFFERING Our first thought in turning to the primitive races of mankind is of a people baffled and defeated by the overpowering forces of nature. The overgrown tracks beset with perils which lead uncertainly through the entanglements of bush, jungle and forest, may be taken as an illustration of the native's haunted, hunted pass- age through a world of which he knows little and fears much. The narrow footway affords no distant vision, it is bounded on either hand by a tangle that no one seeks to penetrate, and it is marked by the menacing signs of wild beasts or with the war marks of opposing tribes. For such a people, living in and accepting such conditions, there is no thought or hope of order in the uneasy universe ; creation is at once un- intelligible and unintelligent, and this disorder is due to "innumerable agents whose conduct can neither be anticipated nor understood and who must be cir- cumvented by bribery and cunning and expiation". The whole external world is thus invested with human personalities and human passions, and since the external world, as known to a savage, is often enough overwhelmed by calamity, he imagines that these personalities are for the most part hostile to him. In Africa " loyalty to tradition left by the ances- tors and now jealously kept is the true practice of religion," and the African recognizing no true order in the universe has laid hold of custom as something that has been sanctified by use and thus, in some sense, represents a law on which he can reckon. Anything contrary to custom is accounted witchcraft. His worship is tribe worship and the vague being that stands EVIL SPIRITS AND MEDICINE MEN 5 for God, Unkulunkulu, is in reality only the Tribe Ancestry, while the immediate ancestors the Amatongo are the dispensers of disease and death as well as of prosperity and success. In some parts of Africa little spirit houses are built near the other huts ; they are not more than 8 to 1 2 in. high and there offerings are made to appease the departed spirits of a father or grandfather so that he may not return to plague his relations. For this reason on the death of an import- ant member of the tribe, slaves were frequently sacrificed so that they might accompany the spirit into the other world, there to serve him and wait upon him so that he should be kept quiet and contented. The grave of a chief's mother was shown to a traveller not long since in East Africa, where over a thousand slaves had been killed, for the woman had been much respected in the tribe, and all the villages round had contributed slaves for sacrifice at her death. " Do not remember to take care of us," the people say anxiously at a burial, for none can guess in what mood the spirit will return even though they endeavour to meet his insatiable appetite with their offerings of cakes and beer that are placed upon the grave. Again, among the wild tribes of British Malaya the spirits that inhabit nature or natural phenomena are held accountable for the visitations of smallpox, fever, and every other imaginable ill. " There are horrible creatures who shoot the arrows of disease into the careless passer-by, birds whose prey is the health of human life, ghosts who live on trees and pounce on anyone who passes underneath, and ghosts who live 6 THE CLAIM OF SUFFERING in the rivers to drag down the swimmers." In Borneo all suffering is attributed to malignant demons, and once during an outbreak of cholera 500 natives went down the river in their boats in order to entice the spirit of cholera to follow them out to sea. " Here sickness," they shouted, "come along and we will give you pork and dog's flesh." But it is not only among primitive races that such animism is found, even the great Eastern systems of philosophy have been powerless to clear away this tangled undergrowth of belief. Hinduism shelters no less than three million gods who are for the most part village deities intended to keep at bay the evil spirits, but who, being themselves liable to fits of bad temper, must be cautiously and regularly propitiated lest they inflict the very evils they are supposed to avert. In Chota Nagpur every pagan household has a " home demon " or bh&t who lives in an earthen pot, or in a peg driven into the floor, or in a hollow bamboo. In Burma, notwithstanding its claim to Buddhism, shrines may be constantly found to the Nats or evil spirits. Outside the village of Nyoung- Lu-Pin there was a great peopul tree inhabited by a Nat named Myin-Pyoo-Yin, nobody might pass the tree without taking off his sandals, nor break a twig from the tree on pain of death. And Dr. Copleston, the Metropolitan of India, has told us that the Bud- dhists in Ceylon " people every wood with demons, go to Hinduism for the personal guardians of house and crop and the personal wielders of luck and pestilence, and go to the basest sorcery for the personal agents of EVIL SPIRITS AND MEDICINE MEN 7 malice and ill will ". The common people of Western India also believe that cholera is a punishment sent to men by an evil goddess who is called Murree Ali or Cholera Mother, and they fancy that any attempt to take medicine excites her more, and that the proper way to get rid of her is to bribe her with offerings to go elsewhere. Small temples are built in her honour at the extreme limit of village or town so that the goddess may be a little removed from the homes of the people. These temples are neglected except in times of epidemic when the devotees of the goddess and her shrine, who are drawn from the lowest caste, are brought into considerable prominence and derive much profit. It is much the same in China. There the Feng- Shui or science of wind and water determines by its mystical principles the lucky sites and lucky days, for all are under the influence of local genii. Thus an ancient book of charms contains a list of good and evil days as well as describing the various methods for the treatment of sick children. The day and hour when the child first fell ill must be noted, and then if there is a corresponding day and hour in the book of charms the remedy will be found, and also the name of the evil spirit which has caused the sickness. It is no wonder that Mrs. Isabella Bishop asserted that demonism is the force that really under- lies all Asiatic religions ; they do not ask what is the cause of the illness but who is the cause, and spell must be met by counter spell and magic by further magic. 8 THE CLAIM OF SUFFERING Hence there springs up the race of witch doctors, sorcerers, and medicine men, who claim to be mediators between the seen and the unseen, who are supposed to be able to undo spells, to exorcise demons, and to name the terms of reconciliation. And these men minister by fear to the sick man at the moment when his mind is most helpless and most confused. The Ngcira of Africa has been made familiar by many tales of mystery and adventure. He makes himself hideous with tails and skins and feathers, long chains made of the bones and teeth of animals are festooned round his neck, and when he comes to visit the sick man and to discover the evil that has possessed him, he leaps and shouts and waves his magic stick. "Why is this woman sick? Because she has a swarm of black beetles inside her. He applies intelezi (medicine) and asks the people if they do not see the black beetles coming out. Or it is a snake that has got inside her backbone, or a lizard in her stomach, which must be drawn by a cow-dung poultice. He applies the poultice and there, sure enough, is the lizard which he took care to apply to the face of the poultice before he applied it." It would be impossible to estimate the number of the victims of the Ngcira's deceit and cunning, or to describe the horrors of " smelling out " and kindred practices now abolished by the British Government. Only a short time ago the native parliament in Toro (Eastern Equatorial Africa) condemned the witch doctors and declared their trade to be illegal, this action being taken on the initiative of the natives HOSPITAL AND SCHOOL AT BANTING, SARAWAK EVIL SPIRITS AND MEDICINE MEN 9 themselves without Government intervention. Hence- forward if a witch doctor is discovered he is to be im- prisoned ; and this decree has already resulted in several hundred of these men being brought into court. When they were examined as to their sup- posed intercourse with the spirits some of them answered, "Tukabiha abantu kwonka" — "We were just deceiving the people " ! "In Borneo," writes a missionary, "when some one is ill, the village folk use certain drugs which they prepare from roots found in the jungle, some for internal, some for external use. When all that can be taken is taken, and all that can be smeared on the body is smeared on, all washing is stopped, and the friends of the sick man consult together and decide that the witch doctor must be called in. His dress is peculiar: he wears a long garment of any colour reaching to the ground, and on his head is a curious cap decorated with feathers, beads, and bells. In his hand he carries his wand of carved bamboo, on which fowl's feathers have been tied and fowl's blood has been sprinkled, and on his back he has his medicine chest or basket. As he approaches the village where the sick person lives, his friends beat loudly on gongs and drums to frighten away the evil' spirits. He mounts the ladder leading to the sick-room and enters noisily, sometimes shouting. He places his medicine basket by the little palm which is always set up in a sick-room in Borneo. Then he proceeds to examine the patient and having decided what the illness is he returns to his basket and begins to walk slowly round io THE CLAIM OP SUFFERING it and the palm, singing his incantations. Faster and louder he continues until he is racing round the palm and singing at the top of his voice. The drums and gongs are still being beaten outside (imagine the suffering of the patient while all this noise goes on) and at last, it may be some hours after, the witch doctor falls in a stupor or faint, and a friend covers him with a blanket. His spirit is supposed to have gone into the spirit world to find and recover the sick man's spirit. For a long time he lies there, then there is a movement ; he sits up, rubs his eyes as if awaking from sleep, and looks as though he does not know where he is. Then he approaches the sick man and, claiming to hold in his hand the spirit that he has re- captured from the nether world, he proceeds to rub it into the patient's head." Turning to British Malaya we find that there also the sorcerer is the greatest power in the community ; he is possessed by familiar spirits and he prophesies, he can also extract the invisible darts of the demons of disease. He is not even buried like a common man but he is exposed on a tree or hut so that his familiar spirit may tear open his body and release his soul to re-enter a tiger. All such witch doctors and sorcerers are fully provided with a stock-in- trade of amulets and charms. The Ngcira has his "intelezi" or spell medicine for every occasion, he can use it to anoint the assegais before battle, or to cure sickness, to give protection against snakes or cro- codiles, or yet again to cause rain or find lost articles. Near the Albert Edward Nyanza the witch doctor EVIL SPIRITS AND MEDICINE MEN it carries a small skin bag with stones inside so that it may be rattled to represent the speech of the evil spirit concerning the sick man. In India the Hakim or medicine man goes forth in much the same way to exorcise spirits or to suggest some sacrificial remedy with the aid of drums and gongs and innumerable amulets and charms. The true aboriginal charm usually consists in a piece of some root, a bunch of bear's hair tied on to a string that is worn round the neck or arm, leaves, human bones, pebbles, quartz, and small pieces of skin ; in Chota Nagpur the tooth of a donkey that had been killed by a tiger was considered unusually potent. Black and white marks on a child's forehead are supposed to avert the evil eye, and at Hazaribagh an earthen saucer with some chalk marks upon it was held closely before the face of a young mother, so as to give as little air as possible without actual suffocation, in order to hasten the birth of her child. Many of the charms or treatments employed are intended to give vicarious strength, as in the case of a young man who came to consult Dr. Aspland of Peking about a big raw wound on his arm. At first he would not confess the cause, but eventually he was induced to explain that his mother had been ill for some months and that as her strength was failing he had hacked out a great piece of his own flesh which had been stewed to a broth and given to her ; it is a fine story of self-sacrifice even if actually it could avail nothing. The Hindus and Mohammedans alike believe in the value of amulets, which are vended by various quacks and which consist in general of some 12 THE CLAIM OF SUFFERING words written on a small piece of paper and enclosed in metal cases. The late Dr. Pennell (of the C.M.S.) in his book " Among the Wild Tribes of the Afghan Frontier," describes a fakir in Afghanistan who saw three or four hundred patients at one sitting. He would ask a question as to the nature of the illness and then write out a charm ; as each applicant had to pay 5 pice as a fee the man was probably earning about 50 rupees or £3 6s. 8d. a day. He entertained Dr. Pennell at the rest house that evening and made no secret of the fact that he played upon the credulity of the people, and when, after dinner, his assistant came to say that many people were still clamouring for charms, he hastily tore a piece of paper into squares and wrote off the required number. The jungle dwellers of Chota Nagpur and elsewhere sacrifice cocks and other fowls to conciliate the powers that send jungle fever and malaria. Dr. Muller, of Delhi, was called to attend a poor woman whom she found in a moribund condition, quite unconscious and in a very high fever. The horns of some animal were put at her feet and a cock freshly killed was cut open and applied to her head like a cap. Again, in Ram- nad, a medicine man was called in to a bad maternity case, he began by shaving the girl's head, then a fowl was killed and cut open and an incision made in the girl's scalp, the fowl was placed over the wound and after it had been well soaked in oil was set alight. A few hours later the girl died. Such tragedies are the more frequent in India as motherhood is supposed to be specially under the influence of evil spirits. EVIL SPIRITS AND MEDICINE MEN 13 This accounts for the following description by Dr. Muller of a maternity case in a Nawab's house at Karnal: "I was led through a courtyard, that was crowded with weeping women, into a room the door of which was heavily screened with thick and very dirty curtains. Inside it was quite dark and the air so noxious with charcoal fumes that it was impossible to stay for a minute without feeling sick and dizzy. Having removed the curtains and the three charcoal stoves, I saw lying before me on a very humble bed a newly made mother who had begun to show signs of tetanus. The nurse and her other attend- ants one by one had been obliged to go on the roof to inhale fresh air. All nervous disorders are especially ascribed to evil spirits, and the exclusion of fresh air and burning of charcoal appear to be necessary adjuncts of the ceremonies for their exor- cism, so I am afraid that in spite of my advice the charcoal fires and curtains were replaced as soon as my back was turned." Dr. Mildred Staley, when working at Delhi, gave three accounts of exorcism. " I found a woman delirious with fever after childbirth. She was propped up in a sitting posture on a filthy bed in a dark cupboard and beside her crouched two old crones, one on each side. Grasping her hair in their long lean hands, they occupied themselves in violently shaking her backwards and forwards with all their might and main, tearing out handfuls of her hair in their vigorous efforts to evict the evil spirit with which the poor creature was supposed to be possessed. All but the back part of her hair had 'thus been pulled out and she i 4 THE CLAIM OF SUFFERING was evidently starved as she swallowed some milk with avidity." " One sometimes sees terribly sad cases of neglect and starvation of the sick. One poor woman whom I was called to visit had primarily suffered from a slight and curable disease, but she had not been allowed anything, not even a drop of water to wet her lips for five days. This was by order of the native magic men who wished to starve out the evil spirit which they said had caused the illness. She must have gone through great agony, but was quite past hope when I saw her, and died a few hours later — starved to death." The third case was that of a young Mohammedan girl of sixteen who was suffering from consumption and had been under treatment from the local medicine men, this consisted in violently shak- ing the poor child backwards and forwards for hours together until she died from exhaustion. In contrast to these efforts to evict and avoid the demons we hear of a mother in Ping Yin, North China, who threw her two-year-old baby away to die. His convulsions had frightened her so she had given him to the devil, and that the devil might know his own she had daubed patches of black paint upon him and tied pieces of dog-skin round his wrists. The poor little baby was brought to Miss Phillips at the S.P.G. mission and found to be suffering from meningitis ; the mother was sent for, and she was no longer afraid when she found her baby sleeping quietly under the influence of bromides. It is to be expected that people living under the shadow of such dark and vindictive forces are filled EVIL SPIRITS AND MEDICINE MEN 15 with suspicion and mistrust even of those who would help them. Not long since a Chinese official fled from a Christian dispensary in horror, as he was certain that the castor-oil capsules that he had seen there were the eyes of little children gouged out by the Christian doctors. And there was a widespread belief among the frontier tribes of Afghanistan that the British Government was seeking by vaccination for a young girl whose veins flowed with milk instead of blood that they might carry her off to England for sacrifice. The conception formed by most of the primitive race is that of a multitude of gods who are at variance with one another, and are not superior but rather inferior to the men who seek to propitiate them. The people can give but little answer to the problem of suffering beyond the fact that it is vindictive and malicious, and fear has so confused their minds that they have prac- tically never tried to find any remedy or alleviation. Indeed instances and examples might be multiplied indefinitely as practically every non-Christian race affords some illustration of the underlying belief in demonism and the suffering it has caused. It is into such a chaos of creed and custom that the medical missionary brings his offer of help, and claims that the "interference" is not wholly unjustifiable. He brings a faith founded on the supremacy of God, and indeed the first step in the conquest of pain is to acknowledge that God is supreme over all His works, a moral Power above creation. In this faith we are able to move for- ward in confidence that disorder will yield to order, that light will shine increasingly upon our darkness. 1 6 THE CLAIM OF SUFFERING This was the answer given to Job that brought him hope in the midst of pain ; and it is this knowledge which will at last dispel the uneasy mists of ghosts, and ghouls, and evil spirits that add a thousandfold to suffering and disease, and that will give the patient, hitherto kept tense by anxiety and alarm, the con- fidence to commit the keeping of his soul to God in peace "as unto a faithful Creator". II. QUACKS AND CURES. It is curious that medicine and the healing art have made such little progress among the ancient races of China, Persia, India or the Moslem world whose civiliza- tion had been long established before Europe had awakened out of sleep. The need of suffering human- ity is so direct and so urgent that it seems almost in- credible that they have made no advance and little effort to inquire into the cause and to relieve the effect of disease. Yet such is indeed the case ; and it forces the question as to whether some essential germ of life and of wisdom and power has not been missing from their development. The Christian Faith in teaching the Fatherhood of God and the Brotherhood of man has quickened the sense of love and sympathy and responsibility in the hearts of men ; they have been forced through all the ages to put that faith into action and, notwithstanding innumerable mistakes and even unworthy ideas, it has brought them to a clearer understanding and a greater wisdom. The fruit of the Spirit is love, it is the natural and essential outcome of the Gospel ; but among the gifts of the Spirit are wisdom, and counsel, and understanding, and this en- richment has come in a wonderful degree to those (17) 2 1 8 THE CLAIM OF SUFFERING nations who accept the Faith of Christ — they do move forward into light. If we would study an arrested civilization we have only to turn to China that great nation of 300,000,000 people who invented the com- pass and discovered gunpowder before the Christian era, who invented printing five hundred years before Gutenberg and to whom we owe the culture and manufacture of silk and the making of porcelain. Archdeacon Moule in a letter addressed with great re- spect to the scholars of China was able to congratulate them on the great age of their institutions and dis- coveries, and the age and importance of their literature. He alluded to the fact that competitive examinations had been in vogue for twelve hundred years and that the Han characters now in use are, at least.two thousand years old, and that Ch inese paper and pencils are of about the same date. Yet we can hardly say that their pro- gress as a nation has gone on unhindered and un- checked, and when we turn to their study of medicine and disease we find that they have apparently made no advance at all. According to Chinese tradition the semi-mythical Emperor Shen-nung is accredited with having written the first medical treatise as early as 2700 B.C. Possibly he was a contemporary of Hammurabi of Babylon in whose famous code we learn that " If the doctor has treated a gentleman for a severe wound with a lancet of bronze and has caused the gentleman to die, or has removed a cataract of the eye for a gentleman with the bronze lancet and has caused the loss of the gentleman's eye, one shall cut off his QUACKS AND CURES 19 hands ". However that may be, and notwithstanding this excellent beginning made by Shen-nung the state of medical science in China to-day is probably at lower ebb than it was at the time of Hippocrates, and the knowledge of anatomy is certainly inferior to that of ancient Greece or Rome 2000 years ago. A later Chinese saying informs us that "Medicine, fortune- telling, astrology, physiognomy may all be taken up as a trade or profession (as a diversion) by scholars," but it hastens to add that only the last is really respectable. In a land governed by examinations it is strange that no examination or qualification of any sort has been required for a man to start practice as a doctor, in fact the medical profession still continues to be frequently used as a refuge for those who have hopelessly failed in other pursuits. The functions of the body are explained by the mystical terms of the Yin and the Yang or the positive and negative, the male and the female principle in nature, and sickness is supposed to be some disagreement between these forces. Until quite recently no dissection was allowed in the Chinese Empire so that the anatomy of the body was decided by the most ingenuous guess-work. Nothing is known of the nervous system or of the circulation of the blood, and every organ except the brain is said to have a pulse. The heart is considered by them to be the centre of being and therefore it must also be in the centre of the body, the liver with its seven lobes contains the motor centres for the eyes and the soul, and the larynx goes straight through the lungs to the heart. The Chinese also be- lieve that the brain is in the stomach, and an amusing illustration of this is given by Prof. Cooper of Shanghai, 20 THE CLAIM OF SUFFERING who once told a Chinese doctor that he had great difficulty in learning and remembering more than twenty fresh characters of the Chinese alphabet each day. The doctor promptly advised him to get up very early in the morning and then eat his rice so as to keep the characters literally in his mind. The Siamese hold an equally surprising theory of anatomy. They have decided that as the whole of nature is composed of the four elements of earth, air, fire, and water the human body must be of similar construction, and that, further, it is composed of twenty different kinds of earths, twelve kinds of water, six kinds of wind, and four of fire. According to the medical opinion of Siam fever is caused by a dispro- portionate amount of fire as dropsy is by too much water, and there are exactly ninety-six diseases in all to which the body is liable. In China the doctors responsible for such compli- cated mechanism are divided into two classes, the internal and external, or, as we would say, the phy- sicians and surgeons. The external doctor boldly professes to be able to puncture the body with a skewer in no less than 367 safe places in order to "let out the wind," for they maintain that wherever there is swelling there must of necessity be wind. As these 367 safe places include the lungs and the stomach the results may be well imagined, and acupuncture is re- sponsible for diseased joints and deep, suppurating wounds, if not for blood poisoning and death. Miss Phillips, M.B., when at Ping Yin described some aspects of Chinese medicine '* Pinching, thump- QUACKS AND CURES 21 ing, kicking, twisting, and needling are all practised here, and it often gives more trouble to undo the effects of the treatment than to cure the original complaint. Pinching seems, however, to be very soothing to hysterical women and we often see them with a collar of bruises round their necks. Needling is extremely common : the professional needle is a lancet-shaped instrument with a handle of twisted wire, but the domestic article is more commonly used and some- times disappears into the part under treatment." The Chinese still probe the abdomen with red-hot needles as a cure for cholera, or thrust needles into the lungs for pneumonia. Medicines are often very expensive, and they are extremely complicated in composition, the idea being that if one of the ingredients fails to suit the patient another will probably succeed. Some medicines may have as many as twenty or more different ingredients which all require to be boiled together and taken at a draught. The effect of taking a bowlful of hot nauseous liquid at night, followed by the heaping of all the family bed-clothes on the top of the patient, often causes a profuse perspiration which is probably the most beneficial effect of the medicine. If the first dose fails to effect a cure, another doctor is called in, and so on till recovery or death takes place. A list of medicines recorded in a missionary journal gives a good impression of the " benevolent art " as practised in China : — " Flies are of great use to man, for their heads when pounded and used as a pomade form an infallible hair 22 THE CLAIM OF SUFFERING restorer for head, beard, and eyebrows. . . . Bats are harmless animals and of great value in medicine. Their flesh applied as a poultice is a sovereign cure for the stings of scorpions ; roasted and eaten they dry up the excess of saliva in infants. . . . There is nothing better for that dangerous disease, lethargy, than to put fleas in the patient's ears. . . . Certain devout and religious people have been known to put bugs in their beds that they might be more wakeful to contemplate divine things . . . one purpose of their creation was doubtless to keep us from pride . . . but the main object of the creation of bugs was for the benefit of the sick. They are of remarkable efficacy in the hysteria of females, if one puts them in the patient's nose. Seven bugs taken in barley water are of great value in quartan ague and for the bites of scorpions." It is interesting to note in passing that the germ that causes leprosy has actually been found in the house bug and it is probable that the disease is trans- mitted by its means. Such " benefits for the sick " are indeed unexpected! The following prescription was used by a Chinese doctor : " Powdered snakes, 2 parts ; wasps and their nests, i part ; centipedes, 6 parts ; scorpions, 4 parts, and toads, 20 parts. Grind thoroughly, mix with honey, and make into small pills. Two to be taken four times a day." A charming picture of a medical missionary of the seventeenth century stands out in grateful contrast to such practitioners. Fr. Bernard Rhodes of the Society of Jesus was probably the earliest Christian physician in China, and the account of his work that has come QUACKS AND CURES 23 down to us is written by his contemporary Fr. Parennin. " When his talents were known, and when experience had shown what was his skill in surgery and pharmacy, and even in the knowledge of pulses and diseases, they esteemed him much more. . . . 'What a difference,' they often said, 'between this European physician and the physicians of our nation. They lie boldly and undertake at great risk to sick persons to give remedies for diseases they know not, as well as those they know. . . . That man on the contrary speaks little, promises little, and does much. . . . Nothing disheartens him, he is always the same. His charity extends impartially to everyone, to the poor as to the rich. On leaving our apartments he goes to our stables to visit our servants ; he attends them, he con- soles them, he heals them. The only thing that gives us pain is that we know not how to induce him to receive the least trifle, merely to make such a proposal is to displease him, and to make him run away.' " The use of counter-irritants and cauteries have, of course, their place in medical treatment, but to apply boiling oil or fire to a wound is a somewhat drastic exposition of the principle. Boiling oil was commonly used in Europe to stop the bleeding of gunshot wounds until Ambroise Pare, the Huguenot surgeon of Charles IX of France, was unable to obtain a fresh supply of oil while acting as surgeon to the French army in Turin. " At last," he wrote, " my oil ran short and I was forced instead thereof to apply a digestive made of the yoke of eggs, oil of roses, and turpentine." The result was so satisfactory that he " resolved never more to burn 24 THE CLAIM OF SUFFERING thus cruelly poor men with gunshot wounds ". This treatment, so long discarded in Europe, is still continued in the East. Not long since a poor Indian woman was brought to the St. Aidan's Mission for Indians in Durban, and the medical missionary found that boiling oil had been poured upon a small wound which had in consequence become an open sore half a foot square. Throughout the East little fires will be lighted in three or four places over the painful area on the patient's body, sometimes by means of a brownish powder partly made of saltpetre, sometimes by means of small pieces of rag, about the size of a shilling, steeped in oil. This invariably leaves a bad sore, which may heal by slow degrees, and it is no uncommon thing to find as many as fifty scars on a patient's body as a result of such applications. In one case brought to a mission hos- pital for treatment it was found that a South Indian mother had actually held her little boy's hand in the fire by way of healing a small wound. Sores such as these which have probably been caused in the first instance by ignorant treatment are usually plastered with mud and cow-dung which forms a hard crust under which the ulcer spreads and putrifies. Dr. Mildred Staley, when at Delhi, had to attend a little boy who had been plastered in this manner for several months. She had to poultice constantly for three days before she could get his head fairly clean, when it was found that the whole scalp was one deep ulcer. Another case was that of a woman treated in St. Catherine's, Cawnpore, who was suffering from severe bruises across her chest, which had been smeared with OUT-PATIENTS, ST. LUKE S HOSPITAL, NAZARETH DOCTOR, NURSE AND PATIENT IN OPERATING ROOM, ST. CATHERINE'S HOSPITAL, CAWNPORE QUACKS AND CURES 25 cement made into a paste with some sort of vegetable ; she is described as looking as if she had been rolling in the mud. Such plasters are used in cases of suppura- tion ; if the discharge continues to find its way through, more layers of mud and cow-dung are added. The use of such disagreeable applications is probably largely ceremonial, for it is no uncommon thing for a high- caste lady to send her servants to purify the ward which she is to occupy in the hospital. This they do by washing the floor, walls, and bed with water from the Ganges. These are then rubbed over with cow-dung. Burnt rags are spread over an inflamed joint and poultices are -used; these are somewhat better than the plasters, for they are usually composed of figs, or the leaves of the castor-oil plant, or pounded- up cactus plants. A pitiful case in Cawnpore was that of a boy whose badly burnt hand had been soaked in ink for some time by a native doctor, this left as might be expected an unusually troublesome wound that took long to cleanse and heal. Ophthalmia and ulceration of the eyes are exceedingly common through- out the East, and the usual remedy is to rub some kind of powder into the eyelids ; pepper is commonly used for this purpose, or charcoal which has been ground to a powder and mixed with alum, or with bits of powdered teeth and bone. A further source of such diseases may be traced to the custom of " cleaning " the eye- lids which prevails in China. The barber turns them over to scrape them, and when inflammation ensues the process is repeated until it results in permanent injury to the eye. Leeches are constantly employed in India for all manner of swellings. " I had seven 26 THE CLAIM OF SUFFERING leeches put on," said a woman in Rawal Pindi who was suffering from an abscess on her finger. " They drank up my strength but they did not drink up the swelling." The abuse rather than the use of splints, and the amazing carelessness and neglect are together respon- sible for the constant cases of gangrene. Splints are sometimes made of layers of very thin pliable pieces of wood, each layer being separated from the other by tow tightly bound round the limb and the whole soaked through with oil. A little boy was thus brought to St. Catherine's Hospital, Cawnpore, with a broken arm. He was screaming in such agony that Dr. Dawson was obliged to give him a small dose of morphia while she attended to the fracture. The injured arm was so tightly fastened that it had been compressed into half the size of the other, the hand and forearm were greatly swollen and the hand was quite cold. A typical case of neglect was that of another boy brought to Murhu, he had broken both arms five days before, one had become gangren- ous and amputation was immediately necessary. Yet another child inTsolo, South Africa, had his foot crushed by a horse, and was left so long without proper attention that his foot actually dropped off from gangrene. We can judge what this means by the description given by the late Dr. Pennell : " In the case of a fractured thigh a sheepskin is tied on, a rough splint applied externally and often left for a week or more. When there has been an open wound and the patient has been brought several days' journey through the heat down to our hospital at Bannu, you can usually anticipate the QUACKS AND CURES 27 character of the case by seeing the men, who have carried the bed, carefully winding their pagaris round their noses and mouths before proceeding to unband- age it for your inspection, and when it is at last opened all except the doctor and his assistant try to get away as far as possible." It may well be imagined that in such a pitiful con- fusion, where the cure is often if not usually far worse than the complaint, the patients have the vaguest notions of their own symptoms. Mrs. Weston, M.B., of Nazareth, describes the initial difficulty in getting an answer to the question, ' ' What is your age ? " "If this apparently simple inquiry is put through an in- terpreter, there follows a long and animated conversa- tion embellished with gesticulations, at the end of which the interpreter regales you with some remote piece of family history — probably some land dispute between different connexions of the patient years ago. If you restate the question with emphasis a similar occurrence may result, but at the long last you get for your answer the approximate age of the patient's eldest son." Dr. Dawson of Cawnpore quotes the answer of a woman when asked the age of her child : "He was born after his uncle went to Bombay," and on being further pressed she added, " It was when flour was dear in the bazaar ". Passing from the age to the " history of the present illness " the patient or interpreter may hasten to give symptoms which they think are suitable to the case. " Are you sure he has such and such a symp- tom ? " asks the white doctor ; " must have, must have " is the answer, but on examination it is found that the 28 THE CLAIM OF SUFFERING account is based on a totally erroneous idea of the nature of the complaint. It is difficult to make a satisfactory diagnosis when the patients describe their illness in such terms as these, " All night long a pigeon danced on my liver," " I have a sensation of a pot boiling in my inside," or " I feel as if a bird was flutter- ing in my leg ". It is more difficult still when it comes to a question of caste, for then it may be that the patient is on one side of the curtain while the English doctor is on the other, and caste prevents him seeing her. These bonds of caste survive even an English education as in the case of a Sikh, house surgeon to a Government hospital. He came one morning to Mrs. Blair, M.D. , at her dispensary in Banda in great distress, for his daughter-in-law, a girl barely sixteen years old, was dangerously ill and he could do nothing for her; incredible as it seems he had never seen her face, and even then he might not touch her beyond feeling her pulse. Mrs. Blair was in attendance for several hours and finally had to tell the father-in-law that he must give the patient chloroform while she operated. He did so, at first administering it through the patient's thin chadder, but before she was completely unconscious the covering was removed, and for the rest of that anxious night there was no further thought of pro- prieties. Yet had there been no woman doctor the girl might have died, though her father-in-law, a fully qualified surgeon, was in the house. Where there is such complete individual ignorance we find, of course, that the health of the community is entirely ignored. Sir Robert Hart has said that QUACKS AND CURES 29 he remembers a coolie being drowned in the mud in the Peking of old days; and drainage, scavenging, lighting, and a pure water supply are unknown in the East unless they have been introduced by Euro- peans. It is probable that if such a place as Mecca could be made sanitary and put under enlightened medical care, there would be a real diminution of the epidemics, the diseases and the suffering of the world ; as it stands it is a menace to the health of all. Dr. Aspland sums up the attitude of the Chinese so far as the general welfare of the community is concerned as that of " Dirt, Disease, and Doubt ". Dr. Phillips, when at Ping Yin, wrote that there were no really clean pools in Shantung, and that she had often seen a mother washing clothes in the greenish-black water of some stagnant pool, while the child at her side was drinking the same water with evident relish. " China," writes another missionary, "is notorious for the entire neglect of proper sanitation. Peking the capital . . . has been pronounced by competent judges as the dirtiest city on earth," and a native Indian army surgeon de- clares, " It is almost needless to enter upon a description of the sanitation of an Indian village, for there is a total absence of it ". Of course there are many quaint stories of the ignor- ance of the common people, some of which may not be altogether unfamiliar to our home experience. " In visiting the poor people," Mrs. Weston tells us, "it does not occur to one at first how extremely simple are their domestic arrangements. It is experience which teaches the desirability of carrying soap and towel and 30 THE CLAIM OF SUFFERING also precludes the hope of anything to wash one's hands in except a brass pot of about half a pint capacity, and having a neck some 2^ in. in diameter." One woman in Africa declared she could not stay in the hospital because the walls were white; a Mohammedan lady protested that she could only sleep with her feet in one direction ; ointment to be applied to a wound has been hung over the bed as a charm ; in Corea tincture of iodine was readily drunk by a sick man, and the pills that were given to a Chinese patient were swallowed "in mistake" by his friend! A story that reminds us of Silverlocks and the teeny weeny bear's porridge was that of small Robert of Pondoland who was not even allowed a taste of his own medicine, for, finding that it had a pleasant flavour, his family swallowed it all. At Ranchi a poor woman was attending the dis- pensary with a fractured wrist and one day complained that she was suffering from indigestion. Miss Poole, who is in charge of the work there, suggested getting some medicine for her, but the woman explained that it would be of no use as the indigestion was caused by her being obliged to eat rice with her left hand, the right hand being often described as the " rice-eating hand". The desire for much medicine is common to all lands, and it is not always easy to explain to simple people the need for operation. This was refused in the case of a little child in Pondoland as her parents could not be made to understand the nature of her illness, a bad abscess in her side. " We wish drinking medicine," they said, " to clear this matter up." Need- less to say " drinking medicine " was of no use and the QUACKS AND CURES $t child died soon afterwards at her home. In East Africa a woman, ill with fever, clamoured for the " akoma " — the little iron thing — that had done her so much good before. It afterwards transpired that she meant the clinical thermometer! Thus we find an impenetrable wall of ignorance that has indeed " hedged in " the people, until the very desire for advance has become foreign to them, and they have lost all ambition or wish to learn. It is true that the " unchanging East " has begun to change, that the old examination halls are deserted, and that there is a thirst for Western education. But that is beyond our present subject. We have only to chronicle the fact that these ancient and venerable civilizations that were able to evolve deep philosophies and a fine and worthy literature while as yet Europe remained dead to all thought of progress, have, notwithstanding, failed to meet the simplest cry of human suffering with an in- telligent response. " The fear of the Lord is the begin- ning of wisdom," we have repeated the words often enough ; may we not now judge by the world's history that advance in thought and enlightenment can only be made where certain foundation principles are to be found. There must be from the beginning a know- ledge of the Divine wisdom, and a clear sense that man is called to receive his share and endowment of it from God. Thus expectation is kindled and the Holy Spirit leads us through the strait places into a city of many habitations. III. THE WEAK AND HELPLESS. A CLOUD of despair seems to hang over the non- Christian races and to render them helpless if they are overtaken by misfortune or calamity. The Moham- medan finds no reason for action when disaster over- whelms him, for it is "Kismet" — an unalterable fate, while the Buddhist only seeks to suppress sense and emotion and to practise indifference that he may attain to complete detachment. Thus he finds his ideal in the face of the Buddha, a face of cold and apathetic calm. So long as the lovelessness of God and the helplessness of man is taught, it is impossible for joy, that further fruit of the spirit, to come to fruition ; men cannot gather grapes from thorns or figs from thistles. Where, then, we look for mastery the East only looks for escape or helpless, weary resignation. To the Christian pain may become a factor in man's moral, intellectual, and spiritual life; we do not deny its existence nor underrate its sting, but we seek, with confidence, to use it and in due time to conquer it. So we believe ourselves to be by God's will masters of our destiny, and acting on this assurance we have seen disease retreat from territories where hitherto it (32) THE WEAK AND HELPLESS 33 has held supreme. But it is otherwise when men are overshadowed by the thought of an inexorable destiny, for there they make no effort to seek protection and it naturally results in a vast disregard for human life. The great visitations of flood, famine, and pestilence find them totally unprepared ; they make no attempt to understand, to investigate, or to overcome, and they are left as they were found, helpless and indifferent. The "Lancet" of 16 July, 1898, published the answers to certain questions addressed by the French Statistical Department to the Pasha of Damascus : — " Q- What is the death-rate per thousand in your principal city? A. In Damascus it is the will of Allah that all must die ; some die old, some young. Q. What is the annual number of births ? A. We do not know ; God alone can say. Q. Are the supplies of drinking water sufficient and of good quality ? A. From the remotest period no one has ever died of thirst. Q. General remarks on the hygienic conditions of your city. A. Since Allah sent us Mohammed, His prophet, to purge the world with fire and sword there has been a vast improvement. But there still remains much to do. Everywhere is opportunity to help and to re- form. And now my lamb of the West, cease your questioning which can do no good either to you or to anyone else. Man should not bother himself about matters which concern only God. Salem aleikum ! " 3 34 THE CLAIM OF SUFFERING On the Afghan frontier a political officer asked a chief whether he would like the Government to open a dispensary where the sick might be healed and cared for. " Sir, it is not what we want," was the answer, " there are already too many of us ; a pestilence to carry off half the people would be much more welcome." In most Oriental towns the death-rate is estimated at over 45 per 1000; and though we have indeed little to boast of in England in regard to the question of infantile mortality, yet we have at least reduced it to under a 100 per 1000 births, as against an infant death-rate in Bombay of 593 per 1000. Naturally such fatalism presses very harshly on the weak and disabled, for it is taken for granted that any affliction not in the nature of ordinary illness is irremediable ; and that as it was probably caused by sin committed in some former life, it is a just punish- ment to be borne without complaint and regarded without pity. There are, for instance, two hundred thousand or more lepers in India and, approximately, six hundred thousand in China and two hundred thousand in Japan, all of whom are left unrelieved and unassisted on this account. If, as in the case of India, there is any offer of Government assistance or Government segregation, they are taught that it can be of no avail and that nothing remains but the per- formance of certain ceremonies by way of atonement. Such an institution as a leper hospital has never been established by native effort uninfluenced by western ideas. But it was given as one of the signs of the Gospel that " the lepers are cleansed," and thus they THE WEAK AND HELPLESS 35 have become an historic charge laid upon all Christian people. The courage that can be engendered by the Christian view of this affliction is best shown by the words of a Japanese leper : " We must not allow our- selves to forget that though we are lepers we still are men, and if we play our part as men we shall at least please the Lord who became Man for us ". The orthodox Hindu is strongly opposed to the education of the deaf and dumb, of whom there are some two hundred thousand in India ; again, it is held that the affliction is a Divine dispensation and none should therefore help the sufferer. It is also stated that there are four hundred and fifty-eight thousand blind people in India and, at least, five hundred thousand in China, yet no one has investigated the causes of blindness nor sought to prevent them. No effort has been made apart from missions to teach the blind or to develop their mental capacities, in fact in the report of the Shanghai Conference, 1 890, it was re- corded that "the Chinese seem to think that besides begging, the only occupation for a blind man is fortune telling and for a blind woman prostitution, and from this sad alternative they are not even protected by native asylums ". The treatment of the insane is still much confused with superstition and belief in diabolical possession. We have not ourselves been very enlightened as to their treatment until quite recent years, and even now very much remains to be done amongst the feeble- minded. But in China the method of treating the insane has been to fasten the patients up in chains, to ex- 36 THE CLAIM OF SUFFERING pose them to all weathers, or to smother them. There is now an Asylum in Canton in South China, and the London Missionary Society has an insane ward attached to the hospital in Siao Kan near Hankow in Central China, otherwise no provision has been made for their care apart from that of starving or beating out the devil, and no attempt has been made at proper feeding, or decency, or normal cleanliness. The same methods are pursued in the Mohammedan insane settlement El Kudr, at Nablous, where the unfortunate people are subject to much actual cruelty. In wonderful contrast to this there stand the words of a medical missionary : " Whatever time I can spare from my ordinary work (in a medical mission) I give to my own particular hobby, which is the care of lepers and of the insane ". But the burden of unnecessary suffering is laid most heavily on the women and girls in eastern lands, for there the inferiority of women is part of the religious belief, and they count for a good deal less than the monkeys, cows and other sacred animals. By the creed of Buddha no woman can enter the desired Nirvana until she has been re-born as a man ; and the common interpretation of the Mohammedan paradise, debased as it is said to be, has helped in the degradation and humiliation of womanhood in Moslem countries. It is hardly necessary to speak of the twenty-five million widows in India, their sorrows have been brought home to all. Many of them are mere chil- dren, and yet they are left to hopeless misery and untold degradation, as they are taught to regard them- THE WEAK AND HELPLESS 37 selves as the cause of their husband's death on account of some sin committed in a former life. The Eastern conception of marriage and widowhood has not only left suffering unrelieved, but it is responsible for end- less ill-health and disease and a pitiful and reckless waste of young life. "The raising of the marriage age," writes Dr. Pauline Root, " was first agitated by missionary physicians," and certainly it is almost im- possible to exaggerate the physical evils of child marriage. Mr. Kopargaon Ramamurthi, B.A., a highly educated and orthodox Hindu, has expressed his opinion with considerable force on this point : " Is not a woman brought up in ignorance from childhood to old age simply to minister to the animal wants of man without complaint or, as Manu would have it, ' kept under control and used for conserving the re- sources of her husband, for economizing expenses, for cooking and for nursing children,' for all the world as if she had no soul of her own to save ? . . . We hurry her through marriage when she is but a little child. We never think of the wrong done to her undeveloped frame, nor do we care if premature motherhood ruins her tortured nerves, and unfits her for ever for the spiritual equipoise which is so essential to her salva- tion. . . . Our religion itself is supposed to cry aloud for her self-annihilation, and to demand greater heroism and self-sacrifice from baby girls than ever a male is called upon to display in his sixtieth year." "These creatures are bad and stupid, what is the use of talking to them ? they can understand nothing." That was the verdict of the men who came 38 THE CLAIM OF SUFFERING up to disperse a little group of women who had eagerly gathered round an evangelist at Karnal. And this judgment of a pitiless fate was expressed in the hard obdurate expressions on the men's faces as they hurried their women away. "They can understand nothing," — and yet " should I not have pity on Nineveh, that great city, wherein are more than six score thousand persons that cannot discern between their right hand and their left ? " Wives are bought like any other goods and chattels and become the absolute property of the hus- band, who may of course do what he will with his own. During a recent famine in China it was easy to buy a woman for the equivalent of a sovereign. This is illustrated by a story from Afghanistan where, as Dr. Pennell tells us, the Afghan adds to the ordinary disciplines of a Mohammedan husband a further right to cut off his wife's nose if she gives him cause for jealousy. "Two years ago," he writes, in his book " Among the Wild Tribes of the Afghan Frontier," ' a forbidding looking Afghan brought down his wife to the Bannu mission hospital. In a fit of jealousy he had cut off her nose, but when he reflected in a cooler moment that he had paid a good sum for her and had only injured his own property, he was sorry for it and brought her to us to restore to her, as far as possible, her pristine beauty. She had a low forehead unsuitable for the usual operation, so I said to the husband that I did not think the result of the operation would be very satisfactory, but if he would pay the price I could purchase him an artificial nose from England, which, if it did not make her as hand- THE WEAK AND liELPLESS 39 some as before, would at any rate conceal the de- formity. '"How much will it cost?' said the Afghan. "'About thirty rupees.' " There was a silence : he was evidently racked by conflicting sentiments. ' Well, my man, what are you thinking about ? Will you have it or no ? ' " ' I was thinking, sir,' he replied ; * you say it costs thirty rupees and I could get a new wife for eighty rupees. ' " And this was said before the poor woman herself, without anything to show that he felt he had said anything out of the common. I am glad to say, however, that he ultimately decided to have the original wife patched up." Yet there are instances of a true and considerate affection, of the husband's anxiety over his wife's ill- ness and of splendid efforts to obtain medical help ; there are men, indeed, who are pleased that their women-folk should have the interest and variety of the Miss Sahib's visit, and that they should listen to her teaching and learn ; but the pressure of a system and a creed are for the most part too strong and the general evils that result cannot be gainsaid. The mortality amongst the girl mothers at the birth of the first baby is terribly high, and the account of two patients, one a maternity case visited by Dr. Mildred Staley when at Delhi, conveys some idea of the ap- parent indifference to suffering that obtains. " One hot Sunday morning I was called by a Hindu o-entleman of good position to see his daughter, before 4 6 THE CLAIM OF" SUFFERING her marriage a patient of mine. On entering the zenana of the husband's house I was directed to a dark and noisome cupboard where I found the patient, a mere child of fourteen, with her baby girl. The stench was fearful and the thousands of flies nearly suffocated one, so I lost no time in lifting her up in my arms off her filthy couch, and carrying her straight out into the purer atmosphere of one of the crowded zenana rooms. Undaunted by the storm of opposition around us, the nurse who had come with me foraged for a spare bed- stead and clean bedding, and we soon had the poor girl laid on it. She told us that since the child's birth, three days before, no one had given her a drop of water, though she was raging with fever and the burning heat of the season. With an experienced nurse planted be- side her, and constant attention, she improved greatly at first, but on the third night a native ' Medicine-man ' was called in by the family, and the nurse was turned out then and there by him. However, the patient called so incessantly for her ' Doctor-Miss-Sahiba ' that eventually her relatives had to call us back again. But it was then too late to save her. The husband seemed greatly amused by my remonstrances, and got married again within a couple of weeks to another little girl. In another large Hindu House a young wife of sixteen had long been suffering from internal abscesses. Going one broiling July day to visit her as usual, it was to find that she had grown faint in the early morn- ing (owing to having been neglected all night by the lazy zenana women), and so, thinking she was dying, the men had thrown her from her bed and bumped THE WEAK AND HELPLESS 41 and dragged her down the steep stone staircase to the lowest floor, where she lay close to the evil-smelling dust-bin, ready for removal when dead. In this, how- ever, she disappointed them, and they presently had the trouble of carrying her all the way back to the zenana ; but at the cost of what terrible suffering to the girls and women are such scenes enacted." In Tripoli a little girl escaped from a harem and fled into the street, but she was caught by four men, two of whom were her own brothers, and, though in the struggle her light garments were almost torn off her, she was hastily carried back. No one will ever know if the child had any cause for complaint or fear, there was no one to take her part, to enquire into her suffer- ing, or to redress her wrongs. We are told that infanticide is by no means ex- tinct in China where the birth of a baby girl is still considered to be ill-omened, but even if it is not so frequently or openly practised as in the past, there is still an untold amount of neglect that constantly ends in death. An African mother gave her baby girl the grim name of Bazarwaki, or " What are they born for? " and the pessimism of this question is re-echoed from the East. And sometimes the answer is one of such dark and horrible tragedy that it hardly bears repeating. There are the baby girls of India who, " married to the gods," are brought up to a life of revolting sin, in which indeed they cannot long survive. It is merciful to learn that the State of Mysore has taken the matter up refusing to appoint new dancing girls to the temples 42 THE CtAlM OF SUFFERING as the others die, so the profession itself may at length cease to exist. These Devadasies or " servants of god," for their hideous calling is ennobled by a fine title, are given or sold as babies to the temple, and are unable to choose or set themselves free, no matter what suffering they have to endure. In China the unwanted baby girls are left, it may be, in some Buddhist foundling home whence, in due time, they are sold as slaves or to a life that is worse than slavery. It might have been of such children that Mrs. Barrett Browning wrote : — And well may the children weep before you ! They are weary ere they run. They have never seen the sunshine, nor the glory Which is brighter than the sun. They know the grief of man without its wisdom ; They sink in man's despair without its calm ; Are slaves without the liberty of Christdom, Are martyrs by the pang without the palm. Are worn as if with age, yet unretrievingly The harvest of its memories cannot reap — Are orphans of the earthly love and heavenly — Let them weep I Let them weep I — Only we cannot let them weep. A short time ago a deputation of leading traders and others came to an Indian administrator with a petition that he should open a local hospital for women on the thoroughly unsentimental ground that the mortality among the young wives was so high as to occasion serious financial difficulties arising from the cost of second marriages. A new opinion is being slowly formed, and there is evidence that the cruel prejudices of old-established THE WEAK AND HELPLESS 4 j custom are slowly yielding to new and more humane ideals. But it cannot be denied that such ideals are of western and of Christian origin, for there even ap- pears to have been an inability to profit by the teach- ing of their own religious leaders who are by no means silent on these points. Mencius, for instance, en- joined pity, and yet you look in vain for any hospitals, or institutions for the lepers or the blind, or asylums for the insane in China. Mohammed proclaimed the man pious who disbursed his wealth among his kin- dred, and to the orphans and the needy and the way- farer, to those who ask, to those who are held at ransom ; but there has grown up an indifference to the weak and the defenceless, and the pilgrimages to his holy city are stained by murder and pillage. Fatalism has no answer for pain. " Therefore whoever comes to witness his beloved one departing from life, let him attend to the holy sages and cease indulging in useless grief, but console himself with the thought that ' In this we cannot have our way '." These words, that formed part of the funeral dirge for Prince Siriva- mosa of Siam, represent the mental attitude of the Eastern people. We cannot have our way — Kismet, it is fate ; and so without resistance they accept the dirt, the disease, the suffering, yes even the sin as in- evitable — and the bitter fruit of this spirit is despair. IV. SURMOUNTING DIFFICULTIES. In contrast to these beliefs in many gods, this de- pendence on a venerable civilization, or the helpless resignation before an unalterable fate, all who follow the Christ are bound by His supreme example to care for the sick and to work for the cure of disease. Our thoughts turn instinctively to the shores of Galilee, to the narrow Eastern streets, to the pleasant hill country : " and when the sun was setting, all they that had any sick with divers diseases brought them unto Him ; and He laid His hands on every one of them and healed them ". So we are not surprised to find that the first hospital in Rome, possibly the first hospital in the world, was raised by a Christian — Fabiola, the friend of Jerome; there she tended the sick with her own hands devoting all her possessions to their use, and finally extended her pity to the out- cast lepers whom she gathered together that she might wash their wounds and heal their griefs. And this work of mercy has been carried on through all the centuries of the Christian era. Dr. Russell Wells points out that those who are engaged in the practice of medicine in England must trace their descent from the monastic practitioners who, like Rahere, first (44) SURMOUNTING DIFFICULTIES 45 founded our hospitals and tended those who were ill. The very hood worn by the doctors is nothing more nor less than the monks' hood, " and," Dr. Wells adds, " none of the teaching schools in London are the product of the State, they are all the product of a desire to practise Christian virtues, and as a by-pro- duct of following our Lord's command, there has come an advance in medical knowledge ". If the Church had been ever in danger of forget- ting the care of the sick it was reminded of this duty in the seventeenth century, by the will of General Codrington. Christopher Codrington was born in 1668 and had been educated at All Souls' College, Oxford, returning afterwards to his native country of Barbadoes and eventually becoming governor of the Leeward Islands at the early age of thirty. Six years later he retired and sought seclusion on his estates in order to study divinity and philosophy. The world he lived in could not have offered great inspiration, slavery was estab- lished and endowed all around him, and the religious restlessness of the time must have been a disturbing element for one who sought the peace of religion. Perhaps he recognized more clearly, in consequence, the needs of the age and summed up the result of his prayerful thought and quiet meditation in his will which is dated 1703. He leaves " My two plantations in the Island of the Barbadoes to the Society for the Propagation of the Christian Religion in Forraigne Parts, erected and established by my late good master William III, and my desire is to have the plantations 46 THE CLAIM OF SUFFERING continued intire and 300 negroes at least always kept thereon and a convenient number of Professors and Scholars maintained there, all of them to be under the vows of poverty and chastity and obedience, who shall be obliged to study and practise Physic and Chirurgery as well as Divinity, that by the apparent usefulness of the former to all mankind, they may both endear themselves to the people, and have the better opportunities of doing good to men's souls, whilst they are taking care of their bodys ". This work of healing is clearly an important Chris- tian duty, and like most duties it is by no means easily fulfilled and needs a firm faith and a good courage if the difficulties in the way are to be surmounted. Medical work can never be the impulse of a moment, for it would be poor science and poorer theology to send inefficient help to those in dire need. The ordinary medical course takes five and a half years, and many examinations and much exacting work must be suc- cessfully accomplished before the training is at an end. Although at a crisis unqualified assistance may have to be enlisted, yet, quite rightly, amateur medical aid is much discouraged. The full medical course must be followed by from six to twelve months' hospital ex- perience, and by a short training in evangelistic work : for the missionary doctor is pledged to the twofold healing of soul and body. This is, perhaps, followed at once by "marching orders," the destination is de- cided (for without talk and advertisement the mission- ary goes where he is sent) and the day of departure arranged. Yet this must largely be a question of SURMOUNTING DIFFICULTIES 47 finance, before now the societies have had to hold back their missionaries for lack of funds. Even if this difficulty is overcome we may fairly give one sympa- thetic thought to that parting from friends and home and kindred, even though it may be a sorrow that is bravely borne by all who find their life's work away from their native land, but which is none the less acute because God's call has come. So the big liner puts out from home, the English coasts fade away and somewhere in the far distance there are people who are waiting without realizing it for the life that has been consecrated, trained, and prepared for their service during at least six or seven years. Nothing is more disappointing than to know what is needed and have to be content with less; the societies feel it bitterly enough, but the keen doctor, fresh it may be from a London hospital with all the newest appliances and an almost inexhaustible supply of nurses and assistants, must find it specially hard to be patient with the makeshift devices and heart- rending surroundings abroad. Medical missions are commonly accounted as the most successful pioneer agency of the Church, but it is indeed pioneer work to open the medical mission and literally to build it up in regard to practice and premises from the beginning. Soon after his arrival in Murhu in 1904, Dr. Kennedy started medical work and it was conducted on the most informal lines in his own house, and as there was much curiosity to see a Dr. Sahib's house the attendance was very large. His tiny study 48 THE CLAIM OF SUFFERING became the dispensary, and the out-patients waited their turn on the back verandah as far as the limited space would allow while the rest sat on a bank facing the house. The verandah, out of which one sitting- room and bedroom opened, had to serve as an oper- ating theatre, and one of the bathrooms was sometimes requisitioned as a hospital ward. One patient, a Hindu, who had his lower jaw removed for cancer, stayed there for three months with his attendant Brahmin and left at the end of that time quite recovered. Two years later he came back on a visit and gave a donation to the little hospital, which had then been built. This hospital would scarcely be dignified at home with the name of Cottage Hospital ; it contained two wards, one with nine beds, the other with five, and a dispensary and operating room combined. At first the only assistance given was by a young lad gradually trained to act as com- pounder, but it was found that when Dr. Kennedy was away during the cold season visiting in the neighbouring villages the attendance naturally fell off, so that, as soon as funds permitted, an Indian Chris- tian surgeon was secured as assistant, and he quickly proved invaluable. The Cottage Hospital has been replaced by a larger hospital with eight wards each containing two or three beds, thanks to a legacy from an English friend and the help of the S.P.G. Medical Missions Department. Dr. Kennedy had already struggled through similar difficulties in Chitarpur towards the end of 1898. There he had begun by camping out under a grove of mango trees, holding EVANGELIST PREACHING TO OUT-PATIENTS, RANCHI DISPENSARY PATIENTS AWAITING TREATMENT, RANCHI DISPENSARY SURMOUNTING DIFFICULTIES 49 his dispensary in the open air until it was promoted to a shed made of spare doors for walls and a carpet for a roof. He pushed on the building of a hospital, collecting materials with wonderful energy and making excursions to Ranchi and Hazaribagh in order to obtain ready-made doors and window frames. Some big timber was required for the roof and there were some suitable trees in a- grove fifteen miles away which was kindly offered for the purpose by the Rajah. But difficulties again arose as the villagers believed the trees to be haunted, and the local Brahmin declared that terrible things would happen if anyone dared to fell them and so disturb the demons who lived in them. Dr. Kennedy had to turn for help to the Mohammedans, who were ready to give some assistance so long as he cut down the trees himself. Directly they found that no harm happened to him they were ready and willing to join in the work. Dr. Kennedy has a genius for making the best of the most unsuitable materials and for starting work when many would give up in despair. Fully qualified medical assistance is a necessity and we should be content with nothing less, but where there are no assistants all must help. Dr. Kennedy was called upon suddenly to operate on a boy with a bad compound fracture of the right arm. While examining it he was able to draw out a piece of the humerus several inches long. There was nothing possible but amputation and this was done at once, the compounder giving the chloroform, and Mrs. Kennedy and Bishop Westcott assisting. 4 So THE CLAIM OF SUFFERING Lack of proper accommodation must be a severe tax on the patience and the nerves. A nurse writing from South Africa describes the one large room in which her work is done. "Just inside the door I see the patients. In another corner my one in-patient lies with a screen to shut her off if necessary. Here I read, write, sew, and teach the native girls whom I am trying to train as nurses. We have meals here and the girls iron and do all their work at the big table." When Dr. Phillips first started medical work in Ping Yin (China) in the spring of 1 906 she had no hospital accommodation though the patients thronged in in un- manageable numbers. " If only I had some kind of hospital," she wrote, "no matter how poor, I should feel contented with it, but I have practically nothing — only one small mud-room in which my patients, their friends, and the Chinese nurse must sleep and eat and live." A year after she reported that " there were very large attendances at the dispensary, par- ticularly on market days (every fifth day). . . . From 1 April till 1 3 July I had 3 1 70 attendances, that is at the rate of 1000 a month, the ordinary number at the busy season or market days is from 90 to 100 each day. On many occasions I have had more : I have had 1 30, 132, 134, 154, and 156 on different days. Last year I had Miss Bearder's help during the first two busy months, but since that time I have been single-handed." During an itinerating tour Miss Phillips began her consultations at 8*30 a.m. one day and, except for a ten minutes' interval at ten o'clock which the people reluctantly allowed her, she continued work until 5 p.m., SURMOUNTING DIFFICULTIES 51 finishing by candlelight after having seen 174 patients in all. There is now a proper hospital at Ping Yin which is the result of such patient endurance and per- severance. In .1906 when work was reopened in Pondoland (S. Africa) after a lapse of twelve years, Dr. Mary Cruickshank started a small dispensary with only two compartments, the roof being of thatch. The first patient who was brought to her was a "bewitched man " who had been dragged from kraal to kraal in the attempt to shake off the spell. At that time none of the drugs or instruments had arrived from England and yet an operation was found to be necessary ; to add to this, on the day fixed for the operation the patient was too ill to come to the small hospital, so Dr. Cruickshank was obliged to go to him. The few bandages which were all that the mission could provide were soon exhausted and towels had to be cut into strips and a needle was used instead of a scalpel. In another case Dr. MacMurtrie of St. Lucy's Hospital, Tsolo, was called to attend a boy fifteen miles away who had been badly gored by an ox ; the patient lay on the floor of the Kaffir hut and the only available light was from a sixpenny lamp, but his wounds were successfully dressed. A second Tsolo boy had his jaw badly injured by a horse ; the broken fragments of bone were joined together and his recovery was com- plete, but, owing to a lack of proper appliances, Dr. MacMurtrie was obliged to use a carpenter's bradawl which was, of course, first sterilized, and some tinned copper wire which had been originally used in an 52 THE CLAIM OF SUFFERING electric-light fitting ; by these means the broken pieces of bone were successfully united. In Corea, Dr. Laws opened his medical practice at Chin Chun in a collec- tion of straw-thatched sheds which were ready to col- lapse whenever there was a gale of wind, and his operations had to be performed on a packing case covered with rubber sheeting. An account of an operation from Rewari (N. India) affords further illustration of the many difficulties that have to be overcome ; it is taken from a letter written by Dr. Marie Hayes, who was called to rest after three short years of crowded work. " I must tell you what happened on Monday, the day when both the patients came in, and when both had to have operations under chloroform, the hospital staff at the time consisting of three, viz. the Biblewoman, the compounder, and one nurse. I got Samokar (the head nurse), however, who was out at a private case, to come and help ; the sweeper- woman's services were also necessary, and even then each one wanted three hands. (Besides these Dr. Muller had come over from Delhi.) When the abscess was opened it was so appalling that the Mihtrani (the sweeper-woman) had to depart at once. A little time longer, and we beheld the anaesthetist gradually falling insensible over the patient's head. Fortunately her part of the proceedings was over, so Sundar (the Bible- woman) holding on to the patient with one hand, lowered the fainting woman to the floor with the other, where she remained until the operation was over." From Delhi and Cawnpore come descriptions of the appalling misery of the Indian homes where, under the THE MAO ENTRANCE, ST. AGATHA'S HOSPITAL, PING YIN VILLAGE GROUP OF PATIENTS WAITING TO P.E SEEN, PING YIN, N. CHINA SURMOUNTING DIFFICULTIES 53 inevitable conditions of dirt and darkness, it would seem that surgical treatment was almost out of the question. " The doors of their rooms are often so low that I have to stoop quite double to get in, and I like to begin by ordering out as many people as possible, for there are usually ten or twelve squatting figures who comment loudly upon the bad symptoms, and re- late how a neighbour died with just such not many days ago. Then I crawl in and try to make out the patient in the darkness until my eyes get used to it and the smoke, or perhaps the people bring a wee taper floating in oil. The patient is generally entirely covered up with a thick quilt well tucked in over her face. I once asked a woman standing by why she did not give some water to a poor old woman lying helpless on the floor of her house ; the reply was, ' How can I give her drink when she is a Mohammedan and I a Hindu ? ' " Again, " Soon after I came here an operation had to be performed in the filthiest house imaginable . . . there was absolutely nothing in the way of comfort for the patient, and cleanliness was only a dream. The floor of mud, partly a swamp, and nowhere to set anything down except the floor, mud walls inhabited by all sorts of living creatures, and such crowds of people ! Our first proceeding in go- ing to a case is to try and get rid of some of the dozens of children who are always about. ' Hat ! Hat ! ' (meaning ' Get out ') is a very useful expres- sion to use to dogs, cats, and small children ; it is not polite enough to use to everyone." "While prepara- tions were being made for the operation the people 54 THE CLAIM OF SUFFERING who were Brahmins were exceedingly particular that we did not touch anything belonging to them. Water would be poured from a vessel held at arm's length high above our basins, their skirts would be drawn together if they came anywhere near us for fear of the slightest contact, with difficulty did I procure all I wanted. It was wonderful to note the change in their attitude towards us after the operation, then they couldn't do enough for us. Water was given to me in one of their own brass pots, I waited for it to be poured out by one of them. But I was told to take it. ' May I touch it ? ' I asked. ' Touch it, why not ? ' was the answer, ' Is not this your house ? ' The mother was determined that I alone should give the medicine I had prescribed. 'You are Brahmins,' I said, ' will she drink it from my hands ? ' ' You have given her back her life,' they replied, 'so why will she not take it from you.' " There are of course many personal discomforts that have to be overcome or forgotten. A long June day in a Delhi operating theatre means no light work when the heat is intense, and if by chance a dust-storm is raging no windows can be opened. In fact in a bad dust-storm it becomes so dark that one can hardly dis- tinguish the windows at all, and there is " dust in your mouth and in your hair (and as one's hair is always wet, there are the elements of mud), dust in your sponge and basin and brushes, the towels thick with it, and the floor, in spite of various sweepings, nearly ready for digging ". " There is a gritty feeling about everything," wrote Dr. Alice Marval, the doctor who was to lay SURMOUNTING DIFFICULTIES 55 down her life in the plague. "I should like to have a duster always tucked into my waistband . . . the insects too of every sort are a worry. Some eat one's clothes, some one's papers and pictures, some bite one, some get into the sugar, some into the ink, making stains everywhere when they come out ; some buzz round the lamp and make it messy all over ; some rush past one and drop with a startling thud upon the floor." Then there are the long journeys in heat or cold to visit a patient, and the doctor must be equally ready to bicycle or ride, to drive in a rough native cart or to walk. Dr. Mildred Staley writes from Malacca in grateful acknowledgment of a parcel of medical accessories sent out to her from home : " Your packet of absorbent wool came just in time, and is already used up for some very urgent clean dress- ings. The very day after it came I was called to perform a major operation on the daughter of a Malay headman some miles away. It was a great triumph to get their consent, and they dreaded the chloroform, but all went well, and I have been going (with the dressings !) every other day though it means a terrible walk on soft mud paths into the heart of a mangrove swamp, all among the most loathsome land crabs and mud fish, and crossing wide rivers on single bamboo poles which wobble." Under such circumstances as these we need to claim that spirit of power, and of love, and of a sound mind which has been promised us and which will enable the workers to overcome all obstacles whether of insuf- ficient help and accommodation, of race or of dim- 56 THE CLAIM OF SUFFERING ate. Indeed it has already transformed the makeshift mud huts or wattle sheds into adequate and well- equipped hospitals, and we look for its influence in the extension of medical work. But the success that crowns the work and satisfies the worker comes when across the wide divisions of race and language, of caste and ritual, love has begun to answer love. Away in Jercherla (S. India) there lives an old Brahmin woman who was the bitterest antagonist of the mission. She used to persuade her neighbours not to come for advice or treatment. " They use the medicines as charms," she would say, " they only want to charm you into becoming Christians, if you go to them you will believe as they do and lose your caste." She was living with a young Mohammedan woman whom the lady evangelist used to visit, and, to mark her displeasure, she always left the house when the missionary entered it. Then she fell ill, and gradually got worse and worse and a carbuncle formed near her knee. No one could relieve the pain, so the young woman who lived with her persuaded her to come to the mission. The poor old soul walked up one morn- ing and the exertion made her faint. The missionaries heard of this and managed to send for her every morning, and when they found out that she was not getting sufficient nourishment they provided that also. Now there is no more loyal friend of the mission, and day by day she may be heard exhorting the patients to trust the mission workers. " I was against them once, but I know now what love means — they are my parents and I am their child. And caste? What is caste? LITTLE GIRL PATIENTS LEAVING HOSPITAL, THEIR GRANDFATHER STANDING ON LEFT, ST. CATHERINE'S, CAWNFORE GROUP AT FRONT DOOR, MALACCA MEDICAL MISSION. DR. STALEY AND THREE ASSISTANTS BEHIND, FOUR PATIENTS IN FRONT SURMOUNTING DIFFICULTIES 57 I believe in the good qualities they show, that is their caste." So also with the Jercherla man who came with a bad back which was entirely covered by cruel-looking ulcers. " Do you know why I am doing this ? " asked the missionary as she gently dressed his wounds. " Yes," he answered, " you are a believer in Jesus Christ and you try to do good to me because you serve Him, and when you die He will call you and say, ' when you were living in Jercherla did you think with love and pity on those in pain ? ' and you will say, ' Yes, Lord'. Then He will say, 'Yes, that is true, and be- cause you did it to them I look upon it as done to Me '." We can overhear the patients talking in the hos- pitals: "What care would you get at home," says Bed No. 1 contentedly, " if you were lying ill there ? Why it would be a great thing if anyone were to pass you a drink of water!" "Your mother-in-law beat you till she broke your arm," says another, "your own mother could not take more trouble than they do here to make it well again " ; and a third, unable to speak as she regains consciousness after chloroform, clasps her thin hands together in mute gratitude. " One face stands out in my memory, typical of many another of India's women," wrote Dr. Mabel Stevenson, " the wife of a poor Mohammedan tailor. Coming into the dispensary tent (during an itinerating tour) she fell and kissed my feet. ' You have come back at last,' she said, ' how I have waited ! What ? You don't remember me ? I, who was blind, to whom you gave sight? Yet daily have I prayed to Allah that you might come back to tell me of your God 58 THE CLAIM OF SUFFERING who gave you the gift of healing' So we went together to her mud hut, and talked much of the Great Physician, Allah's own Son. ' True, true,' she said, 'but how can we remember, we, ignorant stupid women? We will treasure His Name in our hearts, and pray in it, Jesus Christ, Jesus Christ' I can see her standing on her doorstep, waving farewells, half smiles and half tears, and calling, ' Come back soon, very soon '." Surely then the cry of suffering has been heard, and little by little light steals in upon the mystery of pain. We cannot fully understand that mystery even now, but we watch it already retreating where once it reigned supreme, we see it already interpenetrated with love and pity, and compassion ; we recognize already the victory in pain and we look confidently forward for victory over pain. " Why does God let us suffer if He is so good ? " It is a question asked fervently from an Indian sick-bed and the Christian doctor listens for what answer the little Christian native nurse will make. "If God sends the suffering, He sends the good too. And we learn by His suffering how much He loves us — He who was God! and" — the voice hesitates — "a great deal comes from dirt and living in sin." V. THE DAWN OF HOPE. When William Langland in the " Vision of Piers Plow- man " was seeking for an image of the Incarnation, he said that " Truth telleth that Love is the Treacle of Heaven". The words were written in an age when medical science in England was in its infancy though many monasteries and convents had already shown their compassion and opened their doors to the weak, the sick, and the needy. And amid a multitude of distasteful remedies ranging from bitter herbs to boiled adders, Genoa treacle stood out in pleasant and singu- lar contrast, a medicine altogether to be desired. So, indeed, the Incarnate Love comes with wonderful healing and sweetness, a very " Treacle of Heaven " to a world that had vainly prescribed for suffering and sin, by stoicism and fatalism, by theories of retribu- tion and vengeance, and by counsels of unemotional detachment. Love hoping all things has created hope. No one dreads the tender ministrations of love, and because fear is calmed, hope can rise. It is indeed the rare and special flower that springs into life wherever the Christian Faith has passed, Pandora may hastily close her box to keep in the gift, our Blessed Lord has scattered it freely in a despondent (59) 60 THE CLAIM OF SUFFERING world. And the little mission dispensary is a practi- cal illustration of this very practical hope. There are no lack of difficulties, as we have seen, that must be overcome before the doctor can organize his work. Love brings him to the spot, the love which has given him the clear sense of vocation (and here we have a word that is in itself a creed proclaiming the relation- ship of God and man) so that hope follows in natural sequence — " He that hath begun a good work in you will perfect it ". No one can deny the vitalizing force of such convictions, and where the faculty of hope is atrophied there we inevitably find signs of stagnation and decay. Coleridge once said that the best physician is he who can best inspire hope, and much is effected when they who go out to serve are filled with the spirit of confident expectancy. There is a sense of hopeful and healthy good spirits in the account of an itinerating tour that was under- taken for the extension of medical work in the Karnal district in the spring of 1 904. Miss May, a hospital evangelist, thus described the experiences of a camping expedition taken with Dr. Mabel Stevenson. " Our advance into the village was an impressive sight and not easily forgotten. As we approached one of our men donned a certain red leather belt much belettered, and grasping a long stick, his head held high, and with a general air of importance, marched on in front, this being their idea of impressing the multitude ! At a considerable distance followed the bullock cart — a queer straw-sided thing, piled to overflowing with our not too aristocratic belongings — a heterogeneous collec- LEPERS HAVING FEET DRESSED AT JERCHERLA. DISPENSARY HUT IN BACKGROUND DISPENSARY TENT, KARNAL DISTRICT THE DAWN OF HOPE 61 tion of bundles of bedding, bags, tin tubs and buckets, tent poles, and so forth. . . . One thought with a smile of friends in Piccadilly! On the top was perched Phcebe, the little native nurse, like a presiding genius in pink and white, grasping the money-bag. Behind came the three men, and the two Miss Sahibs brought up the rear, hot and dusty — a fitting wind-up ! By the time the camping ground was fixed on, all the village knew that the 'Sahibs' had arrived, and we were surrounded by a large and curious crowd of brown-legged men and boys, come to see the ' tamasha ' (show or performance) for that is what we were to them The first excitement was to watch the foreigners, and the natives squatted down before us in crowded rows while the tents were put up and food was eaten, until at last they were hunted away by Miss Stevenson's Christian servant, a magnificent giant in a red waistcoat with a face and a laugh that did one good. . . . Then to sleep with the sound of the village in our ears, for every village rouses up at night and there was much beating of tom-toms ' to wake the god,' and the boys were singing their queer rhythmic songs in preparation for a Hindu festival, and the dogs were, as usual, howling. " It had been too late to go and spy out the land in the evening, so, after breakfast and prayers with our two Christian helpers, we wandered round the village lanes that are always carpeted with generations of straw and sugar canes, in search of the women. One or two vanished round corners as we appeared, for they thought we were ' Sahibs ' as petticoats are no 62 THE CLAIM OF SUFFERING guide. At last by a sudden turn we came to close, quarters, something seemed to tell them that we didn't bite and they half-uncovered their faces and then one beckoned to us saying, "Ajao" = come. The ice was broken and we went up an outside flight of steps and on to a roof. More women were there, and on roofs beyond still more appeared to join us, till there was quite a crowd ; and then a charpoi (bed) was brought and we sat down. When the doctor was discovered many tales of woe were poured into her willing ears, so I left her with the first group and moved on to make friends elsewhere. Then in a courtyard a catechism would begin : ' How old are you ? ' ' Are you married ? ' ' Why not? ' ' Is the other one your sister? ' — the relation- ship always puzzles the people ; sometimes I was Miss Stevenson's mother, sometimes she was mine, once we were husband and wife ! ' But if you don't do cures, why are you here ? ' This brought one to the point and my book of sacred pictures was produced. Many listened eagerly, especially to the story of the Babe of Bethlehem, and then leading on from the mother's love for her child — the one real motive power in these sad women's lives — I could tell them of the Saviour's love for His lost children. " After a morning's work in a village or by the tents it is always difficult to ferret out the doctor. She was hard at work practically from morning till night see- ing about 500 people in the fortnight and performing many operations. When you got a glimpse of her through the crowd she would be generally sitting just inside the tent with one grimy lady claf >ing one ankle THE DAWN OE HOPE 63 and perhaps two holding the other, and all eyes riveted on her face as she prescribes for one or examines the eyes of another. The dispensary was undoubtedly the key to the situation and opened the door to any teach- ing we managed to give the women. The doctor and her work were a witness to our genuine wish to help them, and often in talking to both men and women supplied a parable which appealed to them as strongly as anything could. ' They that are whole need not a physician, but they that are sick.' And surely the doctor's unfailing sympathy and patience, the skilled and tender hand, and the love which they must have felt was the mainspring of it all, will come back to them now as testimony to the truth of teaching which they only dimly understood. " The humours of the dispensary were many. There was one old lady who came to see the doctor ; it was impossible to discover her malady — she seemed to have none. At last the truth came out — ' I want an English pin ! ' and off she went in triumph. " It was striking that in almost every village there was one man who seemed, as it were, to be waiting for us — ' There shall meet you a man '. In one it was the village carpenter (and this was in a place where the men were very hostile) who took me to his shed, and having called his cronies brought out the tribal hookah, and begged me to join in smoking it — a great honour — then said, ' Now open your book and teach us '. He had heard the teaching of the women in the morning. Women and children grouped themselves about among the shavings, no one saying 64 THE CLAIM OF SUFFERING them nay, for apparently the master of the house is absolute in his own domain, and they all listened in- tently to the story of the Carpenter of Nazareth. " Another time it was the village munshi who begged me to go and teach his wife and children, or the head- man as in Bala. He was perhaps the most interesting person we met ; a tall man with a fine thoughtful face, who had evidently read and thought much — a real ' seeker after God '. Sitting under a tree by the tents, with an audience of about a hundred men, we talked for two hours, this man asking many thoughtful questions. . . . When the meeting broke up, he asked for a quiet talk some other time, and on going to his house in the afternoon, to my surprise he had collected an enormous audience of women. 'Speak to them, Miss Sahib; they can't come to you, I can.' He came the next morning with some twenty more and we had a long talk under our tree. When preparing to go some exclaimed, * Go on, tell us more '. But the head-man said, ' No, in these weighty matters one must not go too fast '. They begged me to stay, if only for one week. ' We will give you a house, and take care of you and all will learn, and next year you will come for six months.' It was hard to refuse such an appeal, and that man haunts me with his sad eyes." It is evident in an account such as this that there is no forcing of religion on a reluctant people, rather there is a movement as of a freshening breeze that stirs after the heat of the day, and it does not seem fantastic to call it hope. We have less doubt as to its nature as we watch in many different lands and 4f< > :J&*f*S* MISSION HOSPITAL, RAWAL PINDI. CONTRACTOR AND HEAD WORKMAN OF CHURCH STANDING IN FRONT MOHAMMEDAN CONVERT AND HER LITTLE SON, ST. Catherine's, cavvnpore THE DAWN OF HOPE 65 among widely scattered people the same eager, pitiful processions that struggle to the mission doctor's door, actuated by the same unmistakable hope. Here is a Mohammedan woman closely veiled who has found her way to the dispensary at Rawal Pindi from her home forty miles away; and another Mohammedan lady from Afghanistan brought by her husband to the hospital at Cawnpore, a camel ride of three days down the Khyber Pass to Peshawar, and thence two days by train. One poor old woman was brought somehow or other to the same hospital with a very bad external tumour, and three weeks afterwards she left the mis- sion completely cured to walk back to her village, a distance of ninety miles; and yet another old body hobbled to Delhi from her village many miles away, in the middle of the hottest weather with a needle in her foot. Here are some Purdah ladies who have probably never ventured before outside their homes. On alight- ing from their carriage they wrap themselves, about half a dozen together, under one large piece of cloth to screen them from the looks of passers-by, and thus the living bundle is received and unpacked. A visit to the hospital or dispensary is quite an event in the mono- tonous lives of many of these rich ladies, for they spend their lives shut up in the Zenanas without any intellec- tual interests or employment. It is specially happy if they can get a few minutes' conversation with the lady doctor to whom they are devoted, after which they can get their medicine, pack themselves up in carriage or dholi, let down the curtains, and so be trotted off home. So strict is their seclusion that at the Durbar they 5 66 THE CLAIM OF SUFFERING were only allowed to witness the ceremonies from be- hind muslin curtains. At Banda every variety of con- veyance can be seen, some come on foot, now and again one on a husband's back ; some half walking, half supported, some "borne of four " on a light bed made of bamboo poles and strung round with string ; others in a dholi or carrying chair, a chair of ordinary dimensions hung by cords from the four corners from a stout bamboo pole carried on the shoulders of bearers in front and behind, in which the occupant sits with knees up to her chin, the cords cramping her still more, and a sheet thrown over all to hide her from the public view. Others come in pony carts of different makes, or in bullock wagons, and it would require a stead- fast hope to bear patiently with the joltings and dis- comforts of the journey. Witness a palmyra climber who was carried six miles to the hospital after a fall of about forty feet, with his lower jaw fractured into five distinct parts, his upper jaw broken, and his thigh very badly fractured. During famine time in Hazari- bagh, some women, who had no friends to carry them, sat down and dragged themselves painfully along. One old woman crawled in this way for two miles, it took her the whole afternoon, and when she arrived she was utterly exhausted. In Inhambane, E. Africa, the medical missionary was greeted one morning with the cry, " Senhora, there is a little girl in the yard with no meat on her leg," and there was a poor little child, grievously ill who was unable to walk and had crawled to the mission, a distance of five miles ! Away in Borneo one might THE DAWN OF HOPE 67 meet some kindly fellows carrying a patient through the jungle over the rough tree trunk paths and hence by boat to the hospital, or Mr. Dexter Allen himself going forth to the villages in search of those patients who were unable to make their own way to consult his wife who is a qualified doctor. We turn to China. This man has come a distance of 300 lis, or 100 miles, from the country with tracho- matous eyes ; he is now ready to go back to his home with sound eyes and a fairly good vision, and is giving the doctor in charge a "Kot'ow" as he bumps his head on the floor in gratitude. Or to Corea where we find an unexpected arrival of patients, some in sedan chairs, some on rough stretchers, made of a plank of wood with a cross-bar- at the end, one is carried in a fruit basket, one on a coolie's back, and lastly there is one who is proudly mounted on a bull ! If we follow them into the waiting-room in the Chemulpo Hospital, we find a crowd of infinite variety. Here is an old man with a white beard dressed in baggy white trousers, a beautiful long white coat, and padded socks ; his black shoes will have been left on the doorstep. His long hair will be strained up into a top-knot with a curious erection which supports his black hat, made of horsehair and shaped somewhat like a Welsh hat. He will probably be smoking a long pipe, much too long for him to light himself, signifying that he has some one to do it for him, generally either a son or a grandson, who always accompanies him and would never think of sitting down or smoking in the old man's presence. Side by side with the magnificent 68 THE CLAIM OF SUFFERING old gentleman there may be a coolie whose clothes, though once white, show very little sign of their original purity. He will have no long coat, only a short one : his hair, though drawn up in the same way, will only have a very dirty towel tied round it to keep stray hairs in place ; his shoes will be made of straw or string instead of leather. Should he also be an old man he will be treated with as much respect as the other, though he be unaccompanied and smoking only a short pipe. Boys are there of all ages — if unmarried, with their hair parted down the middle, well plastered with oil and plaited in a long greasy pigtail which leaves a mark all down the back of their white coats : if married, with their hair done up in a top-knot and with the usual hat. Men of thirty or more, if unmarried, still wear their hair in a pigtail, and are addressed as if they were children — whilst others, barely yet in their teens, if married have their hair up, wear a hat, and are addressed politely as " Mr. So and So ". In the other room, women old and young will be arriving with their heads completely covered with a long white sort of apron, fastening in front and show- ing very little more than one eye. This garment is removed on the doorstep when they find themselves in the presence of women and children only, and dis- closes a very neat head of hair, parted down the middle, well oiled, and twisted low on the neck round a large silver hairpin. Their dress is almost always white, though the younger women often wear figured silk bodices, but whether made of white cotton or st. luke's hospital, chemulpo (with corean houses in the foreground) main hospital building on the left, women's ward on the right CHEMULPO THE DAWN OF HOPE 69 coloured silk, the fastenings are generally plum- coloured strings — plum being the national colour. Their skirts, like a large apron tied round them with long strings, cover trousers, which are made of white calico, and thickly padded with wool in the winter, and which reach to the ankle. Those who can afford to do so, wear white or coloured leather shoes, and the poorer people have straw ones. Children there will be of course, they are dressed in bright colours — boys and girls alike wearing pigtails so that it is often difficult to tell them apart. The babies are strapped to their mothers' backs and look, when asleep, most uncomfortable, with their heads hanging over till you think they must surely drop off So the big crowds come thronging to the various dispensaries and hospitals and there is nothing unusual in an annual attendance of 15,000 to 40,000 out- patients. Sometimes the whole family accompanies the invalid and settles down in the hospital precincts after the embarrassing customs of the East, but they are ready to undertake the cooking in order that the patient's caste may be preserved and the food unpol- luted. Their hopeful faith is wonderful when we con- sider that they consent to operation under anaesthetic at the hands of men and women of a different race, and this confidence is sometimes almost pathetic. " I have told them to come back for me in a month," said one patient, " then you will have made me quite well and I shall go home happy." Or the father who brought his little blind child back to the doctor after the case had been pronounced incurable, for he felt certain that 70 THE CLAIM OF SUFFERING there was the power to heal and that by coming on a different day and pretending to be a different case he might find the doctor in a better temper and ready to exercise his power to restore the sight. Thus from far distances and through immeasurable discomforts these people turn their steps to the cheery little Mission Hospital of Hope — the leper hospital in the island of Kiushui, South Japan, is actually called the Kwaishur Byoin or the Hospital of the Resurrection of Hope — and they have caught some reflection of that hopeful- ness in their lives. What if that hope be disappointed ? The tiny hospital at Rewari had to be closed for a time after the death of Dr. Marie Hayes, as the staff at Delhi were not sufficient to carry on the work. " Poor suffering women came to us repeatedly and begged for treatment ; it was useless to tell them there was no doctor, they counted on our desire to help, that was to them sufficient to establish a cure. One poor, sick village woman met me at my gate one evening. ' Oh, Miss Sahib,' she said, ' if you only knew what I am suffering you would certainly help me. I've come all this distance to see the doctor at Miss Sahib's hospital, only to find her gone and the doors closed. The doctor Miss Sahib and you are my only friends and now she is gone, so won't you please give me some medicine ?'" So from Borneo when Mrs. Dexter Allen broke down from overwork and was ordered home for a long rest. "Oh! Mrs.," a schoolboy wrote to her, "look indeed upon us left by you, because there is no one who can do for us as you did. For instance, my VILLAGE WOMEN WAITING FOR MEDICINE IN THE CONSULTING ROOM, RliWARI HOSPITAL THE DAWN OF HOPE 71 little brother Robert is very, very ill indeed and there is no one to give him medicine, and my other brother has had fever, but he is better now and I am glad of that, but I am very sad when I think of Robert. But they are not the only ones who have been ill — many people have had fever and some have died and some are living." " We in Banting," wrote another boy, " are very sad. Mrs. and Master are not there ; there is no doctor. I have had malarial fever for two months. I wanted to go to Master to ask for medicine and he is not on Mission Hill. If Mrs. comes back to Banting I shall be glad with an excessively great gladness." VI. THE CARE OF PUBLIC HEALTH. We are so proud of our civilization that we have al- most ceased to inquire into its origin and source. If we are confronted with difficulties we are apt to blame God Almighty, if we advance towards success we are ready enough to praise ourselves. Indeed, some fifty years ago, we had come to believe that all that was amiss with the health of the world came from the will of God, and that all prosperity was the result of our own evolution. Then it was that Charles Kingsley had to tell us with no uncertain voice that our boasted self- development had created the bad drains and insanitary properties that bred disease, and that, in contrast to this, the actual will of God lay in cleanliness, fresh air, and health. From the beginning, as we have seen, it has been made clear to Christians that their mission was to heal the body as well as the soul, and they set about the work in the best way that they could, making many mistakes, often nervous and tenacious of privilege and subject to superstition, but nevertheless holding on to the principle of healing in a world that had never before cared for the sick or helpless. It is true that our fingers were gradually loosened, as we believe by the Holy Spirit, from much that we had hitherto held (7») THE CARE OF PUBLIC HEALTH 73 fast, and medical science was specialized and perfected and brought forward into the light of a fuller know- ledge. But we cannot question that it has been given back (like a weapon that has been taken away to be finely tempered) in order that it may be used anew and more effectively in the service of Him in whom it had its origin. To what extent have the medical missions sought to use this knowledge for the good of mankind in the mass ? We have dwelt so long on individual work and in- dividual cases that we must turn now to the efforts made on behalf of whole communities. In England we almost forget the possibility of such scourges as plague, pestilence, and famine ; and reading not long ago of the appearance of plague in Suffolk we wondered with some curiosity, and some incredulity, that people should disturb themselves over a danger so remote. Chickenpox also has had to be made notifiable lest a case of smallpox should escape observation in a genera- tion of doctors who can have had no experience of the graver disease that once ravaged the country. But in the East all this is different. We have already noticed the insanitary and even filthy conditions of East- ern life and the indifference with which they are regarded. We pass on to consider their effect in regard to pestilence and to the efforts made in times of famine. A famine area can be so extensive that a population of twenty- two millions may be affected, as was the case in India in 1 896-7. Relief measures in view of such famines have long since passed from voluntary efforts to a Government department. The famine codes which U THE CLAiM OF SUFFERING have been compiled from forty years' experience pro- vide that the different provinces shall be kept in a state of continual preparedness, and that the Government shall always be fully informed of the prospects and conditions of the crops in the various agricultural dis- tricts. One result may be gathered from the famine years of 1899-1901 that followed swiftly on the famine of 1897, when the loss of life in British districts was estimated at a million, and that among the smaller populations under native rule at three millions. Every mission strained its slender resources to the utmost to meet the needs of the orphans and the destitute, and medical missions naturally bore their share of the burden. In 1907, when the crops failed in the Hazaribagh district, it was impossible to find sufficient hospital accommodation for the patients. " Wherever there was a space we put a patient, and in hot weather we had to put them out under the trees. The diet cards and charts were headed Tree No. 1, Tree No. 2. Some of the babies' arms and legs were like jointed crotchet hooks, and their wrinkled ape-like faces ex- pressed apathetic despair." In this case the famine was followed by an outbreak cf smallpox which carried off numbers of the people and must have entirely exhausted the mission staff. The Government was always ready with its large staff of public vaccinators, but the mission doctors were also kept busy. In one mission in China it is stated that 25,000 people were vaccinated in one year, and in Borneo, Mrs. Dexter Allen, M.B., vaccinated over 2000, and by so doing successfully stamped out a bad ± 4 i i Jr "^ * e'^am * «s THE CARE OF PUBLIC HEALTH 75 Outbreak of smallpox in her district. In Hazaribagh the mission carried out a campaign against the mos- quitoes with the object of diminishing malaria and attained some success. In Africa the medical missions have been eager to work with the London School of Tropical Medicine, and Dr. A. R. Cook and his brother, Dr. J. H. Cook of the Church Missionary Society have long been co-operating with the Government doctors in the C.M.S. Hospital at Mengo in experiments with an injection called "atoxyl," a preparation of arsenic used in the campaign against sleeping sickness. Cholera is ever present, and so long as the people of the East drink from the stagnant ponds and live in a squalor that defies description, it is likely enough to continue. It is unfortunately a disease that develops with great rapidity and unless help is immediately forthcoming it is of little avail. In the autumn of 1908 cholera attacked the valley of Kalasapad. Hun- dreds of cholera pills were promptly manufactured in the small dispensary as they had proved to be of con- siderable value if taken immediately after the appear- ance of the first symptoms. Arrangements were made with the senior mission agents and village teachers for the distribution of the supply and the necessary instructions were given. These apparently simple remedies did much to allay panic and as a matter of fact the Christians suffered very little in the epidemic. This certainly witnesses to considerable initiative in a small medical mission the whole expenses of which, including the salaries of the hospital assistant and assistant compounder, only come to £66 a year. 76 THE CLAIM OF SUFFERING From New Guinea we can draw an illustration of work in a dysentery camp. Nurse Combley writes in a letter dated 20 April, 191 1, from Dogura: — "I have had a truly heavy time since my return from Lake Kamu. Dysentery has been rife in Wedau. The people put up camps between Konbara and Dogura on the flat, and there I nursed them. I never want to see dysentery again, there is no orderly, and isolation work is such rough, heavy work. I had got to my last patient when the storm (on 27 March) came. I was completely in the dark (and very dark it was) for hours with the patient, holding on to the thatched roof to keep him covered. It would have been impossible to have got up the hill to Dogura in the storm. At last we were blown out, and I decamped to another little place, where we had a few square inches of dry ground until daylight." A priest work- ing in the same part adds in another letter, "... daily also I have washed the sores of all who came ; it was a bit against the grain at first, but I had the materials and some slight knowledge, and so I did not think it right to refuse when they came and expected it ". Plague ! The very word conjures up the thought of the Black Death that swept over England in 1348, with a death-rate that is supposed to have reached four million. Or we seem to see the dead cart in 1665, as it passed up and down the narrow streets with the accompanying cry, "Bring out your dead," followed by the furtive, terrified opening of the door that was marked by the red cross and the "Lord, have mercy ". THE CARE OF PUBLIC HEALTH 77 But from these distant memories we pass to the plague as we know it to-day in India or China, a visitation that depopulates and ravages vast tracts of country until it is no wonder that the natives decide that it must be left like a fire to burn itself out. Yet it is being fought back inch by inch, step by step by men and women who have been ready to run every risk, and, if need be, to lay down their lives as victims of the plague for their fellow-men. Science and religion pride themselves equally in this noble army of martyrs, who have gone forth to their work as Ambroise Pare bade men go in 1 568 in his " Book of the Plague ". "Above all things they must remember that they are called of God to this vocation . . . therefore they should go to it with a high courage, free of all fear, having firm faith that God both gives and takes away our lives as and when it pleases Him : but, as I have said before, they must not neglect and despise preser- vative remedies, or we should be plainly guilty of in- gratitude since God has given them to us, having done all things for our good." Such men and women have their reward. From 1 902 to 1 904 plague was raging in Cawnpore chiefly owing to the insanitary condition of the native quarters, and Miss Wynne Edwards, M.D., the senior doctor, and Dr. Alice Marval, the junior doctor, were kept busily employed, and in the earlier days of the epidemic the proportion of recoveries was good. " As we go through the lanes," wrote Miss Marval, " we are constantly stopped and implored to go in and see some one who is ill. When we reach the house the friends 7 8 THE CLAIM OF SUFFERING and relations often fall down before us and touch our feet with their foreheads and clasp their hands and pray to us to ' give good medicine ' for they are poor people, they have only God in Heaven and us on earth and if we do this our name will be great from here to Luck- now. ... In one house there was a young man dying and delirious and his old parents kept imploring me to give " good medicine " to stop the delirium. It would be difficult to exaggerate the dirt and insanitariness of the houses, moreover the sick people are often not allowed to take any medicine until after the fever has lasted three days for fear of ' driving it in '." Miss Wynne Edwards also wrote: "Plague is very bad. Miss Marval happens to be at present outside doctor (they took it in turns so far as possible to do the ' outside ' and ' inside ' work), and has to spend four or five hours a day in the city." Before these letters reached England the sad news had come of Miss Marval's death on 4 January, 1904, to be followed by that of Miss Walden the English nurse on 19 January, and a few days later by the deaths of Phulmani and Nancy, two native assistants. During the year 1905 there was a severe outbreak of plague in Delhi, when four of the native Christian nurses volunteered for plague duty, and thus proved the reality of their Faith by undertaking work that the lowest caste can only be made to do under com- pulsion. In the spring of 1907 there was another bad out- break in Delhi. "There can hardly be anything more depressing," wrote Miss Miiller, " than living THE CARE OF PUBLIC HEALTH 79 in a plague-stricken city. The streets are almost entirely deserted, rows and rows of houses are shut up, and all day long, till one's heart and ears ache with the sound, the funeral cry of the Hindus is heard as they carry their dead down to the river. . . . From long custom it has become a prerogative of the poor and low caste to claim the clothes and even the bed in which their higher-caste neighbours happen to die. In addition to being infected they are usually in an incredibly filthy condition, so that it is not surprising that, with other causes, it is so difficult to deal with epidemics in India. . . . For more than two months we went out every day visiting the poor sufferers. . . . We were usually hard at work for four or five hours, going from hut to hut, washing and cleaning up the sick, attending to the babies, administering medicines, leaving behind with much explanation enough for the next twenty-four hours, arranging for food and milk, beseeching the people to bring out their filthy accumulation of rags, burning them ourselves, disin- fecting their houses, haranguing and cajoling them to come and be inoculated, and often returning home with some in the carriage. The sorrow and suffering and general helplessness which one saw were truly heart- rending ; all business was at a standstill, no wages could be earned, for those who were well were attend- ing to those who were ill, themselves to become victims very likely in a day or two.'' The history of the plague in Manchuria is of such recent interest that we may quote rather fully from Dr. Aspland's account of his experiences. He had 80 THE CLAIM OF SUFFERING been working for some time at a hospital which the S.P.G. helped to support, and when the call came for volunteers he left Peking and journeyed by rail to Harbin, where the Chinese Government had been forced to take action under threat of political interfer- ence from Russia. The medical college of Peking had been appealed to and three of the staff promptly volunteered for work. Dr. Aspland writes : — "My experience commenced after the epidemic had already broken out in the Chinese city of Harbin, and although there had been deaths daily for over two months, the death-rate had not exceeded 200 a day until about the middle of January. . . . After a day or two spent in the purchase of heavy clothing, etc. (the temperature in January is considerably below zero) we settled down in our new home, which consisted of a third-class Siberian railway-car, uncushioned and bare, but thereby more sanitary and more easily disin- fected. Our car was on a siding about half a mile from the Chinese city. It was with something of the feeling of a man going into action for the first time that I made my way to our chief inspecting station in the centre of the city. At that time no military cordon had been formed, and the duties of the police were only feebly carried out, so that, as strangers, we were not made to show passes. As we neared the city we saw a dead man by the roadside ; a little further on, another ; a little later, a man leaning against the side of a house coughing up bloody expectoration, and, as we found out, such a case would be dead in TAKING A PATIENT TO THE PLAGUE HOSPITAL, HARBIN, N. CHINA A CORNER IN THE PLAGUE HOSPITAL, HARBIN, N. CHINA THE CARE OP PUBLIC HEALTH 3t a few hours. Inside the city most of the shops were closed, and the usually crowded thoroughfares were almost empty, except for those engaged in plague work. . . . " The anti-plague organization had, up to this time, been entirely in the hands of the local officials and Chinese quacks, who were reporting great cures from needling and blood-letting ; the death-rate all the time was mounting up by leaps and bounds, so that the daily total on both sides of the railway was 300. With us arrived about twenty Chinese doctors, trained in Western medicine, and thirty senior students from our medical colleges. The head of the bureau was Dr. Wu, a Cambridge man and a British subject, and in his absence I assumed control. The Government sent up 1 100 soldiers, whom we used to establish a cordon round the entire city, and our 800 police were used to form a cordon round the four sections into which the city was divided. By a system of badges and passes no person was allowed to go from one station to an- other. With soldiers, police, and 600 sanitary coolies, we were enabled, when work was in full swing, to visit every house in the city daily, and search for sick and dead. Each of the four sections had its disinfecting station, sanitary station, and plague hospital, whilst outside the city was the large quarantine station. Our quarantine station consisted of a hundred railway trucks, each capable of holding about twenty 'con- tacts,' fitted with wooden bunks and heated with a central stove. Further, we had a suspect hospital for thirty people, a plague hospital for a similar number, 82 THE CLAIM OF SUFFERING a disinfecting building, besides kitchens and adminis- trative buildings for our crowd which some days num- bered about 1800. The whole of this number had to be examined daily by us two doctors and our five students, and we can congratulate ourselves that our death-rate was never more than thirty a day, and our total deaths not more than 5 per cent. In pneumonic plague the infection is carried by coughing, it being necessary to take the infective material into the lungs, and after an incubation of from two to five days, there is bloody expectoration, and death follows in not more than twenty-four hours. A great many of the septi- cemic cases, who had no cough or lung affection, would be quite well, laughing and talking, when we made our rounds in the morning, and in the evening would be on the dead heap. We have never known a single re- covery, and in hundreds of cases the rapidity of the disease was astounding. " Finding it impossible to dig graves, because of the severe frost, we had finally to burn the bodies. A large pit twenty feet square, and ten feet deep was blasted with dynamite, and into this about 400 bodies, some in coffins and others not, would be piled ; then, when sprayed with about forty gallons of paraffin, they burned rapidly and completely to ashes. The simplicity of the process can be judged by the fact that we burnt over 3000 in one day. The epidemic is now over and the death roll was only 60,000 instead of devastating, as we had feared, the millions of North China." Dr. Aspland attended the International Plague Conference at Mukden where nearly fifty dele- THE CARE OF PUBLIC HEALTH 83 gates from different countries studied the problems of pneumonic plague for over a month, and he had the honour of acting as delegate for China, and of being appointed the Medical Secretary of the Conference, while his work at Harbin was alluded to in glowing terms in a speech from the throne. Besides the Russian and Chinese doctors, the hospi- tal assistants and coolies who lost their lives in this epidemic, the United Free Church of Scotland lost a brilliant young medical missionary, Dr. A. F. Jackson. The Chinese Viceroy, Hsi Liang, made a speech at the memorial service held in Mukden in grateful recogni- tion of Dr. Jackson's work. " He went forth to help us in our fight ; daily where the pestilence lay thickest, amidst the groans of the dying, he struggled to ease the stricken, to find medicine to stay the evil. Worn by his efforts the pestilence seized upon him, and took him from us long ere his time. . . . O spirit of Dr. Jackson, we pray you to intercede for the twenty million people in Manchuria and ask the Lord of Heaven to take away this pestilence so that we may once more lay our heads in peace upon our pillows. In life you were brave, in death you are an exalted spirit. Noble spirit who sacrificed your life for us, help us still and look down in kindness upon us all." The latest medical work undertaken by Dr. Aspland has been in the Chinese revolution. He left Peking with his wife to undertake Red Cross work amongst the Imperial troops, but as their wounded were being well cared for in Hankow he crossed the Wuchang river to attend the revolutionary force. " Our hospital 84 THE CLAIM OF SUFFERING is an industrial institute and in it we have 250 wounded, and a daily attendance of about a hundred who come to be dressed, but are not bad enough to be taken in. Oh ! the misery of war . . . the only thing we can say is that we are doing the best we can. Each patient is lying in his clothes just as he left the battle- field. . . . Some have never taken their puttees off, and though in bed for a month there is no arrange- ment for bathing and washing ; and sometimes in the wards, rising above the odours necessarily accompany- ing so many suppurating wounds, is the dominating one of chickens, ducks, and pork being roasted over a charcoal brazier by some kind friend for a wounded relation or patriot." After this experience with the revolutionaries Dr. Aspland was again transferred to the Imperial forces. "The condition of the wounded here is much worse than at Wuchang, for, as it is here more of the nature of guerilla warfare, the modern bullet is not used, but a big lead one which makes ghastly wounds. Further, in a neighbourhood like this, where beggars are so numerous, a man with an amputated arm or leg will almost invariably starve ; the patients refuse amputation, and, after weeks of laborious dressings and attendance, die of prolonged suppuration and exhaustion. So far we are safe, and trust to continue so, but have been a little uneasy because fifty miles from here the brigands entered a Red Cross hospital, robbed it, and shot three patients. But we are still barricaded, and nothing but a very determined force could get in." mm: THE CARE OF PUBLIC HEALTH 85 At the outbreak of the South African War, Dr. Booth (afterwards Dean of Umtata), a qualified doctor, started ambulance classes for the Indian Community in Durban, being helped in this by Mr. Gandhi, the well-known Hindu barrister. When the Government raised an Indian Bearer corps of 600 coolies they were anxious to find men who were capable of taking com- mand and who could speak both English and Hindus- tanee. This was work for which the ambulance class proved specially suited, and they volunteered for service with Dr. Booth as their medical officer, only stipulating that they should receive no pay. They were rewarded with the Queen's medal with clasps for services rendered at Colenso and Spion Kop. In many cases the missionary has been able to in- augurate sanitary reform ; the Rev. W. L. Beard of the American Board in Foochow obtained permission to start a street cleaning corps, and during a visitation of plague at Amoy the native Christians cleansed and disinfected their own homes and prepared leaflets for distribution that others might follow their example. Perhaps this is a cause of the remarkable immunity of the Christians in times of epidemic as compared with other natives. This is noticed in all mission stations, so that a Turkish official once exclaimed, " How is it, O ye Christians; has God spread His tent over you that you are spared?" In a recent official Health Report from Bombay the mortality among low caste Hindus and Mohammedans are 52-95 and 45 - 93 per 1000, among native Christians only 875. This seems truly to bear out by unmistakable evidence that the 86 THE CLAIM OF SUFFERING Christian Faith does allay fear, depression, and hope- lessness and marks an undeniable advance in the health of the community. But if such an advance is to be maintained, it must be followed by careful, systematic, and Christian training. VII. TEACHING AND TRAINING. THE most important part of the work of the medical missionary lies in the training of native assistants whether as doctors, compounders, anaesthetists, or nurses, for the object of the missionary must be to leave a native school of medicine when eventually western help may be withdrawn. It has not always been easy for the medical missionaries to carry out their own ideals and theory of training, for the overworked doctor of a mission station is so beset by patients, sick calls, and the need for immediate operations that he has no spare time for lectures or demonstrations. Yet, as Dr. Aspland reminds us, it is essential that missions should take a principal part in this work in order to maintain the highest ideals of self-sacrifice as well as those of the latest modern research and technical skill, so that the medical service may be founded on a tradition that is God-fearing, pure, and single-hearted. It is well to think of what such a tradition has meant in England, and we may contrast it with the fact that Mrs. Bishop was asked no less than 200 times during her travels for drugs to injure a favourite wife by others in the harem. (87) 88 THE CLAIM OF SUFFERING Dr. Aspland writes : " If you want to help China, now is the time. The rapid advance of all kinds of science, introduced by various nations, unassociated with any religious teaching, makes us fear that China may develop some of the good qualities of modern civilization without the inner spiritual life, in which case her civilization will be dead and empty. The responsi- bility rests with missions. At present ' medicine ' is the only art associated with distinctly religious and missionary influence, and even this is threatened. Tre- mendous efforts are being made by other missionary bodies to keep this one door open, so that, by the establishment of medical schools, we can be assured that the Chinese doctors of the future shall be taught their profession from a standard far above that of commercialism. ' Know ye not that your body is the Temple of the Holy Ghost? ' " It is unlikely that any one missionary society could found and endow such a medical school as Dr. Aspland indicates, but a movement has already been made to group various societies together for this pur- pose. Many qualifications are now required to gain Government recognition and to keep up the prestige of teaching, so that there must be a large and com- petent staff, sufficient and well-equipped laboratories, and a continuity that will remain unbroken notwith- standing the furloughs, the outlying and district cases, and the possibilities of personal ill-health. The C.M.S. have already grouped the various branches of their own work in the Medical School at Foochow, but the college that at present most nearly approximates to TEACHING AND TRAINING 89 the standard aimed at is the Union Medical College in Peking. It was originally started by the American Board, the American Presbyterians and the London Missionary Society, and it has since been joined by the North China Mission of the English Church and the Medical Missionary Association of London. It con- sists of two large buildings, one containing class-rooms, laboratories and so forth, and the other comprising the students' dormitories ; it is hoped that a hospital and dispensary may soon be added. There are fourteen members of the Faculty and eight lecturers ; Dr. Aspland is Professor of Obstetrics and Gynaecology at the college. The American Church opened a medical school in Shanghai and this has been taken over by the Harvard University Medical School and will aim at teaching Hygiene and Public Health, and members of the staff have been drawn from the medical missions. This method of working in a central school is not un- known to us at home, for it has been employed by those London Hospitals who do not possess a large medical school of their own. Hostels and residential colleges could develop round such a central school, where the strong personal influence and the religious teaching, which is of the utmost importance, would not be wanting; but in any case the atmosphere of the school itself would be absolutely Christian, as would the principles, the method, and the inspiration of the work. This suffices to illustrate a movement that has taken effect at Beirut and in India, as well as in China, 9 o THE CLAIM OF SUFFERING and which should help more than anything else in the strengthening, recognition, and usefulness of the medical missions. Christians are already taking a place out of all pro- portion to their numbers in educational and medical work. In June, 1 908, the first Corean doctors took their degrees at the Severance Hospital Medical College in Seoul, and all were Christians ; and it is an in- teresting fact that within eleven years of the Enabling Act that admitted the first Englishwomen to medical degrees, a Chinese Christian lady, Miss You Me Kying, had entered the Women's Medical School in New York and had graduated at the head of her class. Another Chinese Christian lady, Dr. Hii King Eng, was asked in 1899 to accept the position of physician to the household of His Excellency Li Hung Chang ; her skill was so great that she was known throughout China as " the Miracle Lady ". The first Indian lady to enter the medical profession was also a Chris- tian, Mrs. Satthianadhan, better known perhaps as Krupabai ; and for that matter the first Indian women to graduate in arts and law have also been Christians. The training of nurses must not be overlooked, and it is by no means easy to get the steady habits of regular work into the minds of girls who have hitherto only been brought up with a view to very early marriage. In most hospitals the nurses are under agreement to stay for a certain term of years if they are considered suitable. At the end of the term they usually marry and the hospital authorities must con- tent themselves with the thought that they will found TEACHING AND TRAINING 91 purer, cleaner, and healthier homes and be more useful and dependable wives and mothers on account of their training. Dr. Dawson from St. Catharine's, Cawnpore, writes that they come to the hospital at the mature age of sixteen and are mere school-girls with no idea of what nursing means, yet in two years the English nurses are often able to make sensible women and trained nurses out of them. They are a constant source of anxiety, yet their different characters and their unex- pected ways of developing and an unlooked-for aptitude for their work adds much to the interest of hospital life. Very few of them take any pleasure in the theo- retical part of their work, but there are of course excep- tions. One dispenser gave herself up entirely to the study of pharmacy, and for a whole year she could scarcely be separated from a copy of the "British Pharmacopoeia," even keeping the large red book under her pillow at night. At the end of that time she was found in great distress because she had learnt it all, and was weeping like Alexander that there was nothing more to conquer. However the kindly authorities suggested that she should turn her attention to learning English, of which she knew not a word, and the little nurse was comforted. In contras t to this, another young nurse from the same hospital seemed unable to learn anything during her first six months, but developed an extraordinary love and attraction for pets of all descriptions which she always carried about with her. Young squirrels and birds would peep out from her garments in the most disconcerting manner, kittens 92 THE CLAIM OF SUFFERING doomed to death had a way of disappearing into secret hiding-places until all danger was over, when they would reappear to add to the crowd of unwished-for animals already attached to the hospital. A description from St. Elizabeth's Hospital, Karnal, will show us how the most unlikely material may be used for the glory of God and for the good of their fellow- creatures. " Now let us turn to watch the nurse who is teaching a young probationer how to lift a crippled girl. She has a quiet face, seamed and lined, but hardly attractive ; but she is the mainstay of the hospital staff, ready for any emergency and eager to take upon herself the most arduous tasks and the most menial duties. ' Gently Premi ! ' she is saying, ' if you hurry you will hurt her. So ! that is better,' — then to the patient : ' How do I know so well what to do ? I was once ill like you in hospital. Then God cured me, body and soul, and taught me to know and love Himself. Now He lets me spend my days in helping others.' True ! for ten years ago she was an ignorant Brahmin villager, carried into the hospital crippled by rheumatism. Now she is head nurse, one of the most faithful witnesses for Christ in the whole congregation, loved and respected throughout the city. Premi, the probationer, was once a little outcast child, a famine orphan ; now she is on her way to become a useful and self-supporting Christian woman." From St. Luke's Hospital, Chemulpo, we learn some- thing of the difficulty of nursing in a hospital that has not been adequately staffed with European nurses. Night work is a special difficulty as it does not follow iS^__A. CONSULTING ROOM, KARNAL. DR. SCOTT, OUT-PATIENTS AND NURSES BIBLEWOMAN TEACHING PATIENTS WAITING TO SEE THE DOCTOR, KARNAL TEACHING AND TRAINING 93 that the native nurse will be prepared to stay awake all night, even if he is allowed to sleep by day, and he will willingly accept the post and the responsibility and sleep peacefully until he is found out. As a rule whenever there is a patient requiring a great deal of attention a friend will stay with him through the night, and if need arise he can call the boy who sleeps in the ward and send him to fetch the doctor. The idea of women nurses for the men's ward was quite op- posed to native ideas, and the prejudice has only been gradually overcome. Besides the work of training and teaching which is extending rapidly wherever men and money are forth- coming, the missionary associations have been forward in translating and preparing medical literature. In 1889, for instance, a medical handbook was published for the Karens in their own language under the direc- tion of Dr. Strachan, Bishop of Rangoon, a qualified doctor. The Chinese Medical Missionary Association is active in calling meetings in the various branches for discussion of medical and surgical problems and questions of administration, and for the comparison of experience. They have published tracts and pamphlets on sanitation, on the treatment of epidemic disease, and on the care of health and kindred subjects, which have been widely distributed especially during outbreaks of illness; and they have lately compiled an English- Chinese medical dictionary containing 1 5,000 medical terms, the names of diseases and various other medical and surgical subjects. This association which repre- sents a department of Christian service in which 94 THE CLAIM OF SUFFERING theological divisions are not felt, would extend the work of translation and the preparation of Chinese medical books only that it is difficult to set apart busy men for such work and to find the necessary funds. It is largely on this account that the missionaries have been unable to do much research work in the investigation of local illness and epidemics. When we learn that the C.M.S. medical missions, scattered as they are in various parts of the world, have an annual attendance of 1,162,972 patients and a staff of only ninety doctors — men and women — and but fifty-six English nurses, we may realize that there is not much opportunity for anything beyond the arduous work of active practice. The S.P.G. has a considerably smaller staff consisting of thirty-three doctors and fifteen English nurses, but these, with the medical missions of the University Mission to Central Africa, and the Church of England Zenana Missionary Society, represent the largest medical mission sent into the field by any one com- munion. These are some of the foundations that are being laid with such patience and self-effacement by the medical missionaries. Their time seems often wasted by the much serving of tables, and a description given by Dr. Livingstone, one of the greatest of medical mis- sionaries, of all that is expected of the harassed and overworked doctor, may not be inaptly applied to his successors. " A Jack-of-all-trades, he is building houses and schools, cultivating gardens, scheming in every manner to get water, which in the remarkable drought of the TEACHING AND TRAINING 95 season becomes scarcer and scarcer ; as a missionary he is holding meetings every other night, preaching on Sundays, and taking such other opportunities as he can find to gain the people to Christ ; as a medical man he is dealing with the more difficult cases of disease, those which baffle the native doctors; as a man of science he is taking observations, collecting specimens, thinking out geographical, geological, meteorological and other problems bearing on the structure and condition of the continent ; as a mis- sionary statesman he is planning how the actual force might be disposed of to most advantage, and is looking round in this direction and in that, over hundreds of miles, for openings for native agents ; and to promote these objects he is writing long letters to the Direc- tors, to the ' Missionary Chronicle,' to the ' British Banner,' to private friends, to anyone likely to take an interest in his places." And to all these studies there must be added the necessity of learning not only one new language but the many dialects in order that the common people may hear and understand. And these men turning their hands thus willingly to humble tasks are, as Sir F. Champneys, M.D., F.R.C.P., has told us, "not men who found a difficulty in passing their examinations, or men who had wasted their time, or men of no particular force in the hospital, . . . but prizemen, men who were interested in everything they saw and did ". VIII. SOME S.P.G. HOSPITALS. The first medical missionary of the Church of Eng- land was the Rev. F. T. McDougall, Fellow of the Royal College of Surgeons, afterwards Bishop of Labuanand Sarawak, who landed in Borneo in 1848. He quickly recognized the value of medicine in missionary work. " If I had not had the excuse of my medical capacity, I should never have been able to get into the people's houses and gain their con- fidence as I have done." There, amid the mixed population of Dyaks, Malays, and Chinese, the work has gone on but not without grave reverses for lack of men and money. There are two races of the Dyaks, the Sea Dyaks who live by fishing near the sea or on the banks of the rivers, and the Land Dyaks further up in the interior of the country. They are short, wiry little people, capable of enduring much fatigue and they live in long houses raised from the ground by poles in which several families, sometimes as many as thirty or forty, congregate under the head- ship of one man. In 1904 Mrs. Dexter Allen, M.B., started work at Banting in the jungle, almost on the borders of Dutch Borneo, and on the Batang Lupar (96) HOSPITALS 97 River. The mission station is on a hill 200 feet high, and as it is reached by a steep path that ends in a 30-foot ladder up the face of the rock, it is not very easy of access, especially for invalids who are more or less seriously ill. In 1905 the Rajah authorized the building of a cottage hospital, and it was duly built of iron-wood tarred outside and whitewashed inside. "The Dyaks are very pleased with it," wrote Mrs. Dexter Allen when it was first opened ; " already it has five inmates, and we know that many people will come when they hear there is a building with every convenience for them. It is all crudely simple, but as they sleep on the floor and bring their own mats with them, very little furniture is required." There, amid the luxuriant trees, the quiet work of healing goes on, and the natives gather round the " black but comely" little house, the men, with their big hats, or bright-coloured handkerchiefs tied turban-wise round their heads, chewing the betel nut which is part of a Dyak's equipment and is kept in a small pouch round his neck ; the women, gay with brass ornaments, and usually hatless unless they have been working in the rice fields. From Borneo to South Africa is a far cry, but not long after the medical mission was started in Borneo the Rev. H. Callaway, a fully qualified doctor, went to South Africa and soon found ample opportunity for exercising his medical knowledge. Like Dr. McDougall he was also destined to continue his work as Bishop of the diocese, and very soon after his promotion to the newly-formed see of St. John's, Kaffraria, he built a 7 98 THE CLAIM OF SUFFERING small hospital at Umtata. Umtata is nearly 1400 feet above sea level, and another 1400 feet above it, some fifteen miles distant, we come to Tsolo, a small village of about 1 50 people mostly European but forming with the outlying districts a good centre for work among the Pondomisi. It lies high on the veld, rough green grass all around and innumerable sheep and goats scattered over the sunny downs. Here and there the wood smoke from some alfresco feast rises in the clear air, or some little black children innocent of all clothing scamper across the open, or again the black and white crows rise against the wonderful blue sky and a tall stork flaps slowly away with red legs and bill shining in the sun. Nine miles to the south-west we come to the mission of St. Cuthbert's, which lies among the hills, in a cup- like hollow of the downs with its beautiful church built and served by the Cowley Fathers. There, amid groves of black wattle, eucalyptus, fig, apple, quince, orange and lemon trees, we find St. Lucy's Hospital with its resident doctor, Dr. McMurtrie, and the Sisters of St. Mary's Community, Wantage, who, with two trained nurses, undertake the nursing. This hospital receives grants from the S.P.G. In such pleasant surroundings it seems as if no one could be ill, but the eight or ten beds are in constant use, and now and again in an epidemic of " black fever " space is badly needed. On New Year's Day, 1 910, an ox was numbered among the patients, the owner having brought it in some distress to be operated on for tumour in the head. The man would take no HOSPITALS 99 refusal and the operation was duly performed under chloroform with such success that the animal trotted home of its own accord on the following day — al- together an unique experience in the work of a medical mission. Tsolo and St. Cuthbert's pass from our vision like a dissolving view and are replaced by one of the oldest S.P.G. Zenana Hospitals, St. Stephen's, Delhi. This owes its origin to the faithful efforts of Priscilla Winter, wife of an S.P.G. missionary, who, from 1863 onwards, used to distribute simple remedies to the poor around her and to nurse them through epidemics of fever and cholera. Three years after her death in 1881 the foundation stone of a permanent hospital was laid by H.R.H. the Duchess of Connaught. The site chosen was an important one, as the frontage was on the Chandni Chauk, the busy thoroughfare that leads from the Lahore Gate to the Palace. But it was not really suitable for hospital work as the site was very much cramped, necessitating a building of three storeys with steep and awkward staircases, beside being very noisy. The Hindu Temple next door was sufficiently disturb- ing, every night and morning the god had to be put to sleep and awakened, and although it seemed to wake without very much trouble it took an unconscionable time going to sleep. Sometimes the foghorns, drums, bells, whistles, and lutes would be making merry from 6 p.m. till 1 a.m., by which time if the god slept, the doctors and patients were usually wide awake. It was a great relief when the site was sold and the hospital removed to another site, offered by the ioo THE CLAIM OF SUFFERING Government just outside the city walls. The admir- able new buildings were opened in 1906 with ac- commodation for over fifty patients, an operating theatre and out-patients' dispensary, a wing for the nursing staff being added later. The chapel forms a connecting link between this main building and the bungalow for the medical staff. Two wards com- memorate Mrs. Winter and Dr. Marie Hayes ; the latter died from pneumonic plague in 1908, contracted from one of the patients who had bitten her finger whilst she was attending her. A third ward is named after Dr. Annie Harding who died of dysentery. There are now six lady doctors and four English and a number of native nurses on the staff of St. Stephen's, Delhi, who also have charge of the hospitals at Karnal and Rewari. Karnal, on the railway between Delhi and Simla, is a typical country town of North India numbering 25,000 inhabitants who crowd the tall brick and stucco houses in the crooked streets, houses that seem only able to stand up because they are so closely packed together. Dr. Marcia Fishe thus described Karnal : " The city is said to contain 20,000 people and 26,000 head of cattle. About the former I am not sure, but I have met practi- cally all of the latter when bicycling home after sunset without a lamp. They troop out in the morning to feed and back in the evening to sleep with their owners. It is difficult enough to bicycle in the crowded streets, and the only chance of getting along is to cry out ' bachho bachho anewala ' (O man coming towards me) or 'janewala' (O man going from me) or 'baki- wala, bailwala ' (cow-driver, goat-driver) as occasion re- HOSPITALS I6i quires." Karnal is a walled city, and beyond there is a growing suburb of shops and houses for working people, the large market-place is always busy with many com- ings and goings from the country, and is filled with camel carts and ekkas. At one corner there is a large enclosure surrounded by massive walls like a fortress, it is approached by a picturesque gateway and on the inner side there are many small huts and travellers' rooms built into the wall. This is the ancient inn or " serai," built many hundreds of years ago when Karnal was an important city. It may still be a shelter in time of need and in one sense it is that already, for St. Elizabeth's Hospital, the first part of which was finished in 1908, has been built within the walls taking the place of the old hospital which had been practically destroyed by earthquake in 1905. This disaster had indeed disheartened the mission, but immediately after the earthquake the Easter mail brought a letter from a servant girl in England enclosing a postal order for a shilling, and this humble and unsought gift came as a message of hope and formed the nucleus for the ^3000 that was afterwards raised. The following account of the move into the new hospital was written by Dr. Scott in the " Delhi Mission News " :— " I have been through many moves in England but this one in India beats them all. It was very simple and astonishingly cheap, expenses under £1. One low cart with outsides drawn by the most patient pair of bullocks imaginable (the only beings quite unruffled by the whole transaction) took our furniture from the old to the new place, some half dozen men loading at 102 THE CLAIM OF SUFFERING one end, walking along by the cart and unloading at the other. Four whole days this one cart went back- wards and forwards, sometimes making only four journeys, sometimes six in the day, the number depend- ing on whether any other vehicle was encountered in the narrow streets or not. To pass one another was impossible, so the animals had to be unyoked, and the cart pushed back and up the first side-alley. This need not have delayed matters more than twenty minutes, but it usually meant more than an hour, for a long altercation must be carried on first by the re- spective drivers as to which cart should be moved back. That settled, more amicable talk ensues, and also the inevitable hookah is produced and passed round. Then the change is made, everybody in the street standing by to watch, all suggesting and ex- horting, encouraging and commiserating by turns as they think best. Our luggage at last wends its slow, bumpy way down the street, more than one table and chair losing its legs in transit — the corners being so sharp and the walls so overhanging. By Monday (the day before the opening) we had the doctor's house fairly straight, and were as much forward with the hospital as possible. . . . Monday was a day to remember. Quite a large number of out-patients had to be seen for the last time in the old yard. Mean- while the in-patients were deposited on old and make- shift beds, the good ones being sent down in the cart and put ready in the wards to receive their respective inmates. Then processions were formed of patients in carriages, patients on stretchers, patients with g£§g§§gy f fc£g&2&f I _ - . - .. ._ . . . ■■■■ ■ _: ■hd&* 3ULLOCK CART WITH PATIENTS LEAVING HOSPITAL COMPOUND, KAKNAL DISPENSARY AND COMPOUNDER, ST. ELIZABETH'S HOSPITAL, KARNAL HOSPITALS 103 babies and patients without. Then doctor and sister and nurses, all with arms full of miscellaneous articles. Each patient was armed with her own drinking vessel, food-plate and bowl, comb and medicine-bottle. And so the move was made. Darkness fell as we got our last patient into bed in the new place, and our visitors began to arrive from Delhi for the morrow's opening ceremony. . . . Every one was most interested in and enthusiastic about the place, its arrangements, contrivances, the fresh cleanness of everything and the happy-looking nurses and patients in their new clothes. "One Mohammedan patient remarked quite spon- taneously, 'Well, I believed I should see paradise when I died, but here I see it alive '." St. Catharine's Hospital, Cawnpore, presents an at- tractive frontage to the street ; it is a handsome two- storied building on one of the main thoroughfares out- side the city, and deep flower-beds have been made inside the walls flanking the great iron gate, through which one may catch a glimpse of the grass and trees within, while the verandah is covered with bright creepers. The doorkeeper has strict orders never to admit a man unless with very special permission, for " purdah " is strictly observed. The hospital buildings are connected with wide verandahs which are indeed needed as a protection from the hot sun, and from the terrific rains in the monsoon. Then it seems as if a water-spout were descending from the sky turning all the open spaces into swamps and ponds to the huge delight of the innumerable small children who have to be looked after during "mother's" illness. They en- ro 4 The claim Of suffering joy this improvised bathing infinitely more than the bath that is made conditional to their admission into the hospital, and which usually entails a vigorous amount of howling and resistance. The wards as in Delhi bear their loving witness to those who have laid down their lives in the service of our Lord. Sir William Cooper one of the English residents gave the new buildings for the chapel and isolation ward in memory of Dr. Alice Marval, Miss Elizabeth Walden, and the two native assistants who lost their lives in the plague of 1905, and an operating theatre was added as a special memorial to Dr. Marval by her friends and the members of the G.F.S. who had contributed to her support. The staff at the present moment con- sists of three lady doctors (including one for itinerating work), two English and several native nurses. Chemulpo. — The name is still associated in our minds with the Russian-Japanese War, and it was evident that St. Luke's Hospital was serving a worthy purpose when it was turned into a hospital for the wounded Russian soldiers by the Japanese Red Cross Society, more especially as it had been originally built by Bishop Corfe with funds subscribed by friends in our own Royal Navy. It was unfortunate that at this critical time there was no medical missionary in charge of the hospital, but we can at least feel that our building was of service. Come up the winding narrow lanes of the old Corean town, for the foreign quarter lies on the other side of St. Luke's, and there on the side of the hill is the imposing "Tai Moon "or entrance gate, a double door of wood hung in such a manner ttOSflTALS ios as to produce the maximum amount of squeaking. The low thatched houses seem to creep up to the gate like beggars at the door asking for help, and help indeed there is for all behind the gateway. The hospital is built on a long and narrow strip of ground and forms three sides of an oblong. There is the men's ward named in memory of Dr. Landis the first S.P.G. medical missionary in Chemulpo, who used to entertain the patients as his guests in true Corean fashion just as Dr. Laws still does in Chin Chun. There is another men's ward and an operating theatre as a memorial to Bishop Corfe, the founder of the hospital and first Bishop of the Diocese. A women's ward was added in 1908, with a store-room and laundry tucked con- veniently underneath, an arrangement made possible by the different ground levels. The wards are simply furnished to meet Corean taste, the bed made of boards is raised on trestles with a straw mattress and a sawdust pillow, and if the pillow is not stuffed very tightly the patient will tie knots in the cover to make it harder. Every patient is allowed two portions of rice a day, but each portion would be sufficient for three ordinary people ; and when the pickled cabbage and turnip are being cooked in the ward to add relish to the rice it is distinctly preferable to stay outside. St. Luke's had the honour of tending Bishop Turner for the seven weeks before his death ; he was brought there utterly exhausted from overwork, and though several of the doctors from Seoul came over to see if more could be done he had not the strength to rally, and so fell asleep in Christ. io6 THE CLAIM OF SUFFERING Not far from the town of Ping Yin, in North China, and standing but little back from the road, there is the memorial to Sydney Brooks, deacon, the first martyr to fall in the dreadful Boxer Rising of 1 899. He was hastening back to rejoin Mr. Matthews who was, as he knew, alone and in great danger, when he himself fell into the hands of the Boxers, who wounded him in many places, stripped him of some of his clothes, and dragged him from place to place until at last he fainted from exhaustion and loss of blood. It was intensely cold, and as he lay worn out with hunger and barely con- scious, he heard his captors discussing his death. As he had been unbound he managed to slip away in the vain endeavour to escape, but was recaptured and be- headed, his body being cast into a ravine near by. Mr. Matthews was able to persuade the magistrate to recover the body, and with his own hands he prepared it for burial, then, notwithstanding the imminent danger, it was committed to the grave, and all the Christians of the neighbourhood took part in the funeral. At the same time a poor old Roman Catholic woman, a Chinese, was burnt to death ; thus Ping Yin can claim the first European and the first Chinese martyr to suffer at the hands of the Boxers. These two witness to the essential unity of the Church, even though at times difference of race and the diversity of thought may seem to separate us. Here then is holy ground for a hospital, and indeed when the St. Stephen's Memorial Church was finished, the medical mission which had formerly occupied a mud hut, was able to move into the old church. Now it is well HOSPITALS 107 housed in an admirable building planned by and built under the personal direction of Dr. Margaret Phillips, and its timely help is gratefully welcomed by the people of Ping Yin. They are miserably poor, for much of their prosperity left them when the turbulent Yellow River chose out for itself a new channel, and left the town to be subject to continual floodings from the mountain streams. Working out from these large and well-established hospitals there are various smaller dispensaries and much itinerating medical work which it is difficult to describe in detail. With strong centres adequately staffed much more might be done, but the Home organization is often obliged to discourage extension through lack of money. To turn to Colonial work, a medical mission has been started on the smaller islands lying between Vancouver and the mainland of British Columbia, by the Rev. J. Antle, formerly an S.P.G. missionary, and a hospital ship, the "Columbia," can ply between the islands and pick up the patients in need of hospital treatment, and so take them to one or other of the three hospitals. The "loggers" are subject to many accidents and to terrible temptations to drink, so that wounds and illness are very prevalent, and until this work was started there was no possibility of medical attendance for these 3000 scattered people. Criticism is a weapon easily used, but it would be difficult to find fault with the expenses and upkeep of a missionary hospital. The late Dr. Hearn of Hazari- bagh, North India, published the details of such ex- penditure a few years ago, and it was found that the ioS THE CLAIM OF SUFFERING food for one day for thirteen persons cost is. 6|d., with 2^d. extra for fuel. When a new patient comes to the hospital in Hazaribagh he is supplied with a set of four cooking vessels, an earthen pot or harrhia in which rice is boiled, a drinking vessel or chakka, a dabri or plate, and a vessel for holding charcoal called a patila. Thus the support of a patient, exclusive of medicine, comes to about £$ 10s. a year, a sum that can hardly be called excessive. In Corea the salary allowed to each European worker is only £80 a year, and yet we hear of them discussing economy and re- trenchment with the greatest anxiety. It ought not to be so, men and means should be forthcoming ; but we need the spirit of the good Samaritan if the work is to be placed on a surer footing, a spirit which not only generously gives money for immediate need but which is also ready to take future responsibility and to repay gladly any debt incurred in ministering to the sick. IX. AN APPEAL. We have tried to show something of the work of a great department that is covered by the general term of " Missions," and now we would venture to press an appeal for support The Inspector-General of Hos- pitals in Bengal has estimated that 23,000 dispensaries are urgently needed if we would establish one for every 3000 of the population of Bengal ; and there are, at the present time, only 558 government dispensaries. This would practically mean a staff of 23,000 doctors, and even that would fall far short of the provision in England where we have one doctor for every 1400 of the population. According to Sir William Moore, M.D., in an article in the "Asiatic Quarterly," medi- cal relief in India has only reached 5 per cent of the people, and as the work is largely limited to the towns and centres of population, a vast proportion, 95 per cent of the whole, and especially those who live in the villages and outlying districts, are not touched. Even in Calcutta the Health Officer after careful investigation found that " 62 per cent of the persons who died in that city received no medical attendance from any kind of practitioner, qualified or unqualified, Western or (109) no THE CLAIM OF SUFFERING Eastern". Yet we have already gone far to make these people realize their need, and a grave responsi- bility rests upon us if we make no effort to satisfy it. "If anyone seeth his brother in need and shutteth up his bowels of compassion from him, how dwelleth the love of God in him ? " Dr. James Macphail of the United Free Church of Scotland Missionary Society, writing in " The East and The West," from his large experience says : — " To the possible extension of this work there seems to be almost no limit. The people of India are just beginning to feel confidence in Western methods of healing, and the work which has been accomplished, great as it may be considered by itself, is insignificant compared with what remains to be done. Everywhere medical missionaries have the same story to tell. The demand upon their services is far in excess of their ability to supply, and fresh extensions of their work are being continually forced upon them. We prayed that doors might be opened — now the people are praying us to enter the doors that stand open to re- ceive us, and we are held back by the want of means." Not long since a leading article in " The Times " pressed for the establishment of a female branch of the Indian medical service in commemoration of the visit of the King and Queen to India. The writer did not hesitate to describe the appalling waste of life among the women and children, and this naturally means a serious weakening of the health of the general com- munity. Lady Dufferin's fund has done much to relieve suffering, but as the correspondence in " The IN THE ANNE VAUDREY WARD, ST. AGATHA S HOSPITAL, I'ING YIN, N. CHINA ST. AGATHA S HOSPITAL, PING YIN. THREE NURSE PROBATIONERS AN APPEAL in Times " pointed out, the customs of purdah and caste are not observed with sufficient care in the hospitals connected with the fund, so they are not so widely used as they might be nor by the caste they might otherwise reach. The missionary hospitals are very careful to observe the customs of caste and race. And the missionaries have done what they could to meet this enormous need of help, and of the four hundred women doctors in India two hundred are missionary workers. Miss Ruth Pitt in a letter on the same subject says that " Medical missions are not " only "a good thing" as we lightly say in England, they are " absolutely essential," but, alas, she has to add that " they are totally insufficient " ; the reproach of their insufficiency rests upon us at home. We need then on the authority of those responsible for the health of India an immense increase of all forms of medical assistance ; even if we are not able to extend we can at least consolidate. We can work for strong centres, no longer leaving one doctor single- handed in a district as large as our own Eastern counties but containing a far larger population, as in the case of Dr. Henry Fowler of the London Mission- ary Society. We must no longer risk the closing of a hospital on account of the urgent necessity of holi- days for an overworked and insufficient staff; but such a staff can only be made adequate by adequate help from home. The same cry comes to us from China, there is the same insufficiency in Africa, even our own people in the new lands, up country, in the prairie, or in the bush ii2 THE CLAIM OF SUFFERING are deprived of the medical comforts that they have been brought up to depend upon in times of sick- ness. Mr. J. R. Mott, one of the most inspiring leaders in the present missionary movement, who has travelled in nearly every country with eyes made keen by enthusiasm, writes : " In my judgment well-con- ducted medical missions were never more needed than they will be during the next ten years in countries like the Turkish Empire, the Chinese Empire, and Africa. They constitute one of the mightiest and most persuasive of Christian apologetics. In the particular fields which I have mentioned they will do more than any other agency to multiply points of contact with the most difficult classes to be reached by the Christian propaganda. In this time of strained relations between races and nations, medical missions, dominated by the true Christian spirit, will render an indispensable ser- vice as a mediator." We can take the evidence of the late Mrs. Isabella Bishop, who wrote : " I have travelled for more than seven years in Asia as a traveller entirely unconnected with missions, except by sympathy and interest. As a traveller I desire to bear the very strongest testi- mony that can be borne to the blessing of medical missions wherever they can be carried on as they ought to be. On the Western Frontier of China I should say that a single medical missionary might do more than twenty evangelistic missionaries at the present time." Again, apart from the evidence of missionary en- AN APPEAL 113 thusiasts or of travellers, we can turn without hesitation to the testimony of statesmen. When the operating theatre was added to the S.P.G. hospital in Peking, it was chiefly through the help and instrumentality of Sir Ernest Satow and Sir Robert Hart, two of the greatest administrators that China has ever known. Then to the support and encouragement of travellers and of statesmen we may add the appeal on behalf of medical missions which was signed by two hundred and fifty doctors in the diocese of Oxford ; it was made on the following grounds : — 1. Because such work is commended to us on the highest authority — the example of our Lord Himself, the "Good Physician" who went about preaching and healing all manner of sickness, and all manner of disease among the people. 2. Because the Church has the example of her Glorified Head and the authority of Holy Scripture, for using the healing of the sick as one means through which the revelation of God's love may be brought home to mankind. Therefore medical missions should be regarded as an integral and co-ordinate part of the mission work of the Christian Church. 3. Because medical missions relieve an unspeakable amount of human suffering due to the ignorance and quackery of native doctors. 4. Because in the East it is only through qualified lady doctors that it is possible to do anything to heal the diseases of women in the Zenanas. 5. Because of the missionaries themselves, whose 8 ii 4 THE CLAIM OF SUFFERING labours are often crippled and their lives shortened by want of medical aid within a practicable distance, which medical missionaries can supply. 6. Because the history of medical missions is their own best justification. Indeed the history of medical missionaries is their justification, for their history takes us straight to the feet of our Lord and Master. He has told us to " Do this in remembrance of Me," and it is not only of the Sacrament which gives us the enabling power but of every action in His life upon earth. He has shown us the Way, it is for us to follow. And the "healing of the nations " that we bring in His name must be the entire healing of the whole man. The history of Christian medical work proves to us that those who call themselves Christians have not been unmindful of the body, but we can never be unmindful of the soul. There is a legend of St. Francis which remains true as a type and figure of the work of medical missions. Out of love to God St. Francis went to visit a leper " so impatient, so unbearable, so perverse," that none could approach him. But St. Francis " coming close to him, saluted him saying, 'God give thee peace, my brother most dear,' but the leper only turned on his bed to pour out his anguish of soul against God and against himself. Then said St Francis: 'My son, I will myself do this service, seeing thou art not content with the others '. ' I am willing,' quoth the sick man, 'but what canst thou do more than the others.' Replied St. Francis : ' whatsoever thou dost ask, that will I do '. Quoth the leper : ' I wish that AN APPEAL u S thou wash me all over ; for I stink so vilely I cannot abide myself. Thereupon St. Francis forthwith let boil water and with many sweet-smelling herbs ; then stripped him and began to wash him with his own hands, and it came to pass by a Divine miracle wherever St Francis touched him with his holy hands the leprosy departed, and the flesh remained perfectly whole. And as the flesh began to heal even so began the soul to be healed also. . . . And being every whit made whole both in body and soul he humbly con- fessed his sin." It is for this double healing that our appeal on be- half of Medical Missions is made, the Divine miracle of the healing of the soul that is even greater than the conquest of leprosy or of any other disease. " I dressed him and God healed," so spoke the good old Ambroise Pare ; and the medical missionary of to-day tends the sick and the diseased, and God heals them still, but not only in the body, for His power rests upon the soul also, until the man is every whit whole, cleansed within and without. We, in England, can sometimes hardly realize the full meaning of putting on "the new man," but when we see the old dominion of fear, of ignorance, and of despair retreating ; when we see the growth of confidence, of pity, and of knowledge increasing, we cannot but own that it is the result of a new life and of a new power, and that nations are actually being made new in Christ. There is no method of imparting this Divine truth so simple and so direct as that of healing the sick, for it is the Christ life lived among men, it is the Creed n6 THE CLAIM OF SUFFERING in action. Quite lately a local lawyer in Palestine when watching the crowds of out-patients at a C.M.S. hospital, said : " That is the work that sinks into their hearts, and makes them understand the reality of true Christianity ". We, in England, who with Sir Thomas Browne "dare without usurpation to assume the honourable stile of a Christian," have to show the reality of our profession by extending to others those benefits which we are too much inclined to appropriate to ourselves ; and by the witness of our love and self- sacrifice to set forward the kingdom and the knowledge of the Lord. APPENDIX. A great impetus has been given to Medical Mission work in connexion with the S.P.G. by the formation of the Medical Missions Department with its own Secretary and Committee, largely composed of medical men and women, and its own Special Fund, which is kept quite distinct from the General Fund of the Society. A women's Medical Mission Guild, which had been formed by Mrs. Mosse, wife of the Rector of St. Paul's, Covent Garden, in 1905, was the means of stirring up enthusiasm for Medical Mission work among its members, and a desire to see the work greatly extended. This desire found expression in a re- solution passed at the first S.P.G. Summer School, which was held at Lowestoft in 1907. Inquiries were made from the Bishops abroad, which elicited the fact that there was great need for an extension of Medical Mission work in their dioceses. As a result the Department was formed by a resolution of the Standing Committee of the Society passed in the autumn of 1908, the women's Medical Mission Guild becoming the " Special Needs Section ". At the end of 1911, the Society for the Propagation of the Gospel had thirty-two fully qualified doctors in the Mission Field, eight men and twenty-four women, as well as fifteen qualified native assistants working under their supervision. Fifteen British nurses, together with a large number of native nurses and European and native evangel- ists, were working in the missionary hospitals and dis- pensaries. ("7) n8 THE CLAIM OF SUFFERING In India, in the diocese of Lahore, the S.P.G. helps to support St. Stephen's Hospital, Delhi, with its daughter hospitals at Karnal and Rewari. The staff of six doctors, four English nurses and two hospital evangelists, besides two native nurses, compounders and Biblewomen, is large, but not too large for the important work that is carried on in these places and the surrounding districts. The number of out-patients who attended during 191 1 was 38,578, while the in-patients numbered 1487. At Rawal Pindi, in the same diocese, the Society is re- sponsible for the support of a small hospital, which accom- modates twelve in-patients, under the charge of a fully qualified European doctor, with the assistance of a European matron, some itinerating work in the villages also being undertaken. At Cawnpore, in the diocese of Lucknow, St. Catherine's hospital was built by the Society in 1898 ; the work has gone on increasing, and Cawnpore is now one of the largest medical stations. It has a staff of three English women doctors, one of whom does itinerating work in the surrounding vil- lages, two English nurses, and several native nurses. There were over 19,000 attendances at the dispensary in 191 1, while 662 were taken into the hospital. In the diocese of Chota Nagpur, at Murhic, the centre of a large district where two bazaars are held weekly, excellent work is being done by a staff of two priest- doctors, assisted by an English nurse. The hospital contains eight wards with two or three beds in each, where 169 in-patients were treated in 191 1. At the dispensary, 5348 out-patients attended and itinerating work was done in the villages. Dispensary work is carried on at Itki in the same diocese under a fully qualified European doctor with the help of a native surgeon. During 191 1 there were 3646 out-patients. INTERIOR OF WARD. ST. LUKE'S HOSPITAL, NAZARETH, S. INDIA Mm. sr. luke's hospital, nazarkth APPENDIX i, g The Society also helps to support the medical work which is carried on at Ranch', Hazaribagh and Chitarpur in this diocese, each showing about 20,000 attendances. In South India very good work is being done at St. Luke's Hospital, Nazareth, in the diocese of Tinnevelly under the charge of an English doctor, where 18,195 out- patients were seen in the dispensary and 202 patients treated in the hospital during the past year. The doctor also visits in the surrounding villages and supervises the medical work carried on at St. Antony's dispensary in the large village of Chrislianagram, where the majority of the inhabitants are Mohammedans. The medical work is al- most the only means of getting into touch with the women and over 7000 patients were seen during the year. At St. Raphael's dispensary at Sawyerpuram, which is supervised by the same doctor with the assistance of a fully qualified native surgeon, 8000 out-patients were seen and there were 39 in-patients. At Ramnad, in the same diocese, a woman doctor was sent out by the Society to take charge of the dispensary in 1 910. Since then the medical work has increased so much that a hospital has been begun and the first block was opened a few months ago. But the work is much hindered for want of funds, as the number of in-patients cannot be increased until there is more accommodation. Itinerating work is being done in the surrounding villages and 13,076 out-patients attended the dispensary in 191 2. At Tuticorin, in the same diocese, a priest-doctor is doing itinerating work, the S.P.G. being responsible for his salary. In North China, the Society with the help of the North China Mission Association, supports the Church of England Hospital at Peking, where an English doctor, with the help of a fully qualified Chinese assistant, and two English 120 THE CLAIM OF SUFFERING nurses, is doing very good work, though the revolution somewhat interfered with it. At one time it was feared that the hospital would have to be closed, but happily this was not necessary. The number of in-patients was small, as the women's ward was only open during part of the year, owing to the illness of the nurse who was single-handed, only 137 in-patients being received, though the attendance of out-patients was over 13,000. In the diocese of Shantung, medical work was begun six years ago in a small mud hut at Ping Yin, but now there is a fine stone hospital built on rising ground above the city, dedicated to the memory of St. Agatha, and containing three wards opening on to a wide verandah with accommo- dation for twenty-eight patients. In the compound are the doctor's house and the dispensary. The staff consists of an English doctor and nurse with three Chinese nurse-proba- tioners. A second doctor is urgently needed to carry on the work. Branch dispensaries have been established in four of the neighbouring villages. During 191 2 the number of out-patients seen at the dispensary was 7752, while there were 124 in-patients. At Yen Chow Fu, in the same diocese, where many thousands of Chinese pilgrims resort annually to visit the shrine of Confucius, a hospital is being built. A doctor has already been sent out to take charge of the work, and until the hospital is ready is doing dispensary and itinerat- ing work. In Corea, the S.P.G. helps to support St. Luke's Hospital at Chemulpo, where an English doctor is in charge, assisted by his wife, who is a trained nurse, with another nurse and dispenser. Some Corean boys have been trained to help in the wards, where there is accommodation for thirty-six patients. The numbers treated in the hospital during the APPENDIX 121 year were 305, while over 5000 out-patients were seen at the dispensary. At Ay In Hospital, Chin Chun, a village of two or three hundred houses, a doctor and an evangelist are doing very good work amongst patients who come from villages often over forty miles away. In the hospital there are no beds, as the patients sleep on the hot floor in wadded quilts, the hospital being made as much as possible like a native house. During 191 2, 11,105 patients attended the dis- pensary, and there were 133 in-patients. The evangelist visits the patients after they have been seen at the hospital in order to impress upon them what they have heard of the Gospel. At Paik Chun, a small place on the coast, medical work has just been begun by a woman doctor who went out in 1910 to help in the work at Chemulpo. It is hoped that a nurse may be sent out to help her within the next few months. In the diocese of Labuan and Sarawak, Borneo, there is a hospital at Banting in the jungle, where an English doctor and nurse are in charge. The hospital, which is built of ironwood, tarred outside and whitewashed in- side, contains three rooms with a verandah in front, very simply furnished, as the patients sleep on the floor and bring their own mats. The work has so much increased that the hospital needs enlarging and a bungalow is to be built for the use of the nurse and a teacher. The medical work has been invaluable in breaking down heathen super- stitions and the power of the witch doctors. At Malacca, in the diocese of Singapore, the S.P.G. helps to support the medical work which has been started amongst women. An old Dutch house has been adapted for use as a dispensary and hospital. Two women doctors i22 THE CLAIM OF SUFFERING are working there with one English and three native assist- ants. The attendances in 1912 numbered 6752. In South Africa, St. Barnabas' Hospital, at Mkngana in West Pondoland, in the diocese of St. John's, Kaffraria, is assisted by the S.P.G. The work is increasing and a further addition has been made to the hospital owing to the demand for more room for in-patients, twenty-nine of whom were treated during the year, while over 1300 out-patients were seen in the dispensary. The S.P.G. also gives a grant towards the medical work at St. Lucy's Hospital, Tsolo, where the wards are kept well filled by patients of all classes, the in-patients numbering 167 and the out-patients 4707. THE FIRST HOSPITAL AT ST. BARNABAS MISSION, MLENGANA, PONDOLAND WEST BACK OF ETALASENI HOSPITAL, ZULULAND. GKOL P OF HOUSE GIRLS AND CONVALESCENT CHILDREN INDEX. Africa, 24, 26, 30, 41, 51, 66, 85, 97. 122. Allen, Mrs. Dexter, 70, 75, 96. Amatongo, 5. American Board, 85, 8g. — Presbyterians, 89. Amulets, 11. Antle, Rev. J., 107. Aspland, Dr., 11, 79-84, 87, 88. Banda, 28, 66. Beard, Rev. W. L., 85. Bearder, Miss, 50. Bishop, Mrs., 7, 87, 112. Blair, Mrs., 28. Bombay Health Report, 85. Borneo, 66, 70, g6, 121. — witch doctor, 9. Boxer rising, 106. British Columbia, 107. Browning, Mrs. Barrett, 42. Buddhists, 32, 36. Callaway, Bishop, 97. Cawnpore, 26, 27, gi, 118. Champneys, Sir F., 95. Charms, 7, 10, n, 12. Chemulpo, 67, 92, 104. China, n, 14, 18-23, 29, 35, 36, 41, 50, 67, 7g-84, 88, 106, 107, ng. Chin Chun, 52. Chinese Medical Missionary As- sociation, 93. — medicines, 22. Chitarpur, 48. Cholera, 75. — mother, 7. Chota Nagpur, 6, n, 74, 107, 118. ( I2 3) Church of England Zenana Mis- sionary Society, 94. — Missionary Society, 75, 88, 94. Codrington, General, 45. Combley, Nurse, 76. Cooper, Professor, ig. Cooper, Sir W., 104. Copleston, Bishop R. S., 6. Corea, 52, 67, go, g2, 104, 120. Corfe, Bishop, 104. Cowley Fathers, 98. Cruickshank, Dr. Mary, 51. Dawson, Dr., 91. Death-rates, 34, .85, iog. Delhi, 12, 39, 54, 78, gg, 118. Demons, 6, 14. Dogura, 76. Dufferin's (Lady) Fund, no. Edwards, Dr. Wynne, 77, 78. Fakirs, 12. Famine, 73. Feng-Shui, 7. Fishe, Dr. Marcia, 100. Fowler, Dr. Henry, in. Girls' Friendly Society, 104. Hakim, ii. Harding, Dr. Annie, 100. Hart, Sir Robert, 28, 113. Harvard University Medical School, 89. Hayes, Dr. Marie, 52, 70. Hazaribagh, n, 4g, 74, 107, ng. Hearn, Dr., 107. 124 THE CLAIM OF SUFFERING Hindus, u, 35, 37, 40, 56, 79, 85. Hsi Liang, Viceroy, 83. Human sacrifice, 5. Ikdia, 12, 13, 24-28, 30, 34, 36, 38, 39> 47. 49, 52. 54. 56, 60, 70, 73, 75. 77. 85, 91, 99-104, 107, 109, 118. Insanity, 35. Itinerating, 60. Jackson, Dr. A. F., 83. Japanese Red Cross Society, 104. Jercherla, 56. Kalasapad, 75. Karens, 93. Karnal, 13, 60, 92, 100, 118. Kennedy, Dr., 47. Kingsley, Charles, 72. " Lancet," The, 33. Landis, Dr., 105. Laws, Dr., 52, 105. Lepers, 34, 70. Livingstone, Dr., 94. London Missionary Society, 36, 89, in. — School of Tropical Medicine, 75- MacMurtrie, Dr., 51, 98. Macphail, Dr. J., xio. Malacca, 55, 121. Marriage, 37. Marval, Dr. Alice, 54, 77, 104. May, Miss, 60. McDougall, Dr., 96. Medical Missionary Association of London, 89. — Mission Guild, 117. — training, 87. Medicine men, 8, 12, 40. Mencius, 43. Mohammedans, 11, 32, 36, 43, 49, 56, 85. Moore, Sir W., 109. Mosse, Mrs., 117. Mott, J. R., 112. Moule, Archdeacon, 18. Miiller, Dr., 12, 78. Murhu, 26, 47, 118. Murree Ali, evil goddess, 7. Mysore, state of, 41. Nat worship, 6. Nazareth, 27, ng. New Guinea, 76. Ngcira, 8, 10. Nurses, training of, 90. Pare, Ambroise, 23, 77. Parennin, Fr., 33. Peking, 11, 29. Pennell, Dr., 12, 38. Phillips, Dr., 14, 20, 29, 107. Ping Yin, 14, 20, 50. Pitt, Miss Ruth, in. Plague, 77-85. Pondoland, 51. Poole, Miss, 30. Ramamurthi, K., 37. Ramnad, 12, 119. Ranchi, 49. Rewari, 52, 70, 118. Rhodes, Fr. Bernard, 22. Root, Dr. Pauline, 37. St. Francis, 114. Satow, Sir Ernest, 113. Scott, Dr. A., 101. Severance Hospital Medical Col- lege, 90. Shanghai Conference, 1890, 35. Shen-nung, Emperor, 18. Siamese, 20. Sirivamosa, Prince, 43. Smelling out, 8. Sorcerers, 8. Spirit houses, 5. Spirits, 5, 7, 10, 12, 13. Staley, Dr. Mildred, 13, 24, 39, 55- Stevenson, Dr. Mabel, 57, 60. Strachan, Dr. (Bishop of Ran- goon), 93. Tsolo, 26, 51, 98. Unkulunkulu, 5. INDEX 125 United Free Church of Scotland, 83, no. Universities Mission to Central Africa, 94. Vaccination, 15. Walden, Miss E. , 78, 104. Wantage Sisters, 98. Wells, Dr. Russel, 44. Weston, Mrs., 27, 29. Widowhood, 37. Winter, Mrs., 99. Witchcraft, 4. Witch doctors, 8, 9, 10. Wu, Dr., 81. Aberdeen: the university press S.P.G. MEDICAL MISSION LITERATURE MEDICAL MISSIONS, S.P.G. 52 pp. Illustrated. 2d., post free 3d. THE PROPAGATION OF THE GOSPEL THROUGH THE MINISTRY OF HEALING. By the Rev. Dr. Anderson Robertson. 16 pp. Id., post free l|d. THE MEDICAL MISSIONARY: Her Aim and Work. By a Medical Missionary. 16 pp. Id., post free l^d. SERVICE OF INTERCESSION FOR MEDICAL MISSIONS. Id. each, 6d. per doz., or 3s. 6d. per 100 copies. PICTURE BOOK OF S.P.G. MEDICAL MISSIONS. 16 pp. Id., post free l£d. HANDBOOK ON MEDICAL MISSIONS. 4d. FREE LITERATURE. TWELVE REASONS FOR SUPPORTING THE WORD OF A MEDICAL MISSIONARY. THE "BOTTLE" LEAFLET. AN URGENT APPEAL. FACTS ABOUT MEDICAL MISSIONS. THE FIRST MEDICAL MISSIONARY. 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